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Hospital Ramon y Cajal (Madrid) Resumen Abstract La bronquiolitis es una inflamacion de la via aerea Bronchiolitis is an inflammation of the small pequena de etiologia virica que tiene lugar en lactantes airways caused by a viral infection in infants y que cursa con dificultad respiratoria acompanada de and young children, characterized by respiratory crepitantes y/o sibilancias. Bronchiolitis fundamentalmente clinico, no siendo necesaria la is diagnosed clinically, not being necessary realizacion sistematica de examenes complementarios. Supportive care El tratamiento se basa en medidas generales y de and anticipatory guidance are the mainstays soporte, como la hidratacion y la oxigenoterapia. Although the use of Aunque no se recomienda usar de forma rutinaria, bronchodilators is not routinely recommended, puede estar indicada una prueba terapeutica con a one time trial of epinephrine or salbutamol broncodilatador inhalado (adrenalina o? La bronquitis aguda es de Bronchitis is an inflammation of trachea, causa mayoritariamente viral y de curso autolimitado. Viral infections are La bronquitis cronica se asocia a patologia respiratoria the main cause of acute bronchitis, and the de base y aspiracion de cuerpo extrano. Chronic bronchitis bacteriana persistente es una causa habitual de tos is often associated with underlying respiratory prolongada, de diagnostico clinico y con tratamiento conditions. Definicion infecciones virales (ya sea primoin a bronquiolitis es un sindrome feccion o reinfeccion)(1 3). Fisiopatologia clinico que ocurre en ninos Para propositos de investigacion, La bronquiolitis ocurre cuando los L menores de 2 anos y que se bronquiolitis se define tipicamente virus infectan las celulas epiteliales de caracteriza por sintomas de via aerea como el primer episodio de sibilancias los bronquios y pequenos bronquiolos, superior (rinorrea, etc. El tipo 3 se y neumonia, aunque mas frecuente teliales recambiadas conducen a obs asocia a epidemias de bronquiolitis mente se asocia a faringitis y coriza. El bocavirus humano 1 que la proporcion de los diferentes virus Se ha identificado como causante produce infecciones de via respira causantes de bronquiolitis varia entre de bronquiolitis y neumonia en toria superior e inferior en otono e estaciones y anos, el virus respiratorio ninos. Es causa de infeccio bronquiolitis, y presenta un patron esta algunos estudios en un tercio de los nes de via aerea inferior, incluyendo cional. Oca sionalmente es causada por agentes bacterianos (principalmente Myco plasma pneumoniae) (Fig. Es la causa mas frecuente de bronquiolitis, y el virus mas frecuen temente detectado como patogeno unico. En climas templados los brotes se producen en otono e invierno, mientras que en climas tropicales se asocian a la estacion humeda. Se asocia a infecciones de vias aereas bajas en ninos peque nos y en ninos con enfermedades pulmonares cronicas. Porcentaje de episodios mensuales de Bronquiolitis asociados a diferentes virus otono y primavera. La duracion es mas larga en meno causa mas importante de enfermedad res de 6 meses (sobre todo en menores del tracto respiratorio inferior y de hos Factores ambientales como ser de 3 meses) y en ninos con patologia pitalizacion por ese motivo en ninos fumador pasivo, hacinamiento en asociada (displasia broncopulmonar, menores de 2 anos. En nuestro pais es la pueden aumentar la gravedad de la causa de hospitalizacion del 3,5% de bronquiolitis. Complicaciones los lactantes y del 15 20% de los pre En la mayoria de ninos previa terminos menores de 32 semanas de Manifestaciones clinicas mente sanos la bronquiolitis se resuelve edad gestacional. En ninos con bron La forma de presentacion predomi aerea superior de 1 3 dias de evolucion quiolitis grave, sobre todo prematuros, nante es epidemica estacional durante seguido de sintomas de via aerea inferior menores de 3 meses, cardiopatas o los meses frios, de noviembre a abril, con dificultad respiratoria, crepitantes inmunodeficientes tienen mas riesgo con maxima incidencia de noviembre y/o sibilancias, con pico de sintomas en de complicaciones, siendo las mas gra a febrero de cada ano (Fig. La apa los dias 5 7 y posteriormente resolucion ves la apnea y el fallo respiratorio. La mayoria de que ocurre en ninos menores de 2 bronquiolitis pueden presentar difi los ninos han pasado la infeccion al anos y que generalmente se presenta cultades para mantener una buena cumplir los 3 anos de edad. Frecuentemente (en relacion con la taquipnea y el nados, con un periodo de incubacion es precedido de 1 3 dias de sintomas esfuerzo respiratorio) y los vomitos. En caso necesario ble, el hacinamiento y los antecedentes mas arriba) y agente causante. Mas frecuente en prema lactancia materna es protectora frente hospitalizacion se recuperan comple turos y menores de 2 meses. La de riesgo para presentar bronquiolitis la tos se resuelve antes de 13 dias, en hipoxemia es frecuente en bron grave o complicada son: un 90% antes de los 21 dias. Signos de deplecion de volumen en lactantes y ninos estar indicada, especialmente si hay algun signo focal en el examen fisico, Leve (3 5%) Moderada (6 9%) Severa (? Mucosa oral Normal o Seca Parcheada Laboratorio sequedad leve Las pruebas de laboratorio no estan Fontanela Normal Hundida Hundimiento marcado indicadas de forma rutinaria. De todos anterior modos, pueden ser necesarias para eva Ojos Normal Hundidos Hundimiento marcado luar la posibilidad de: Infeccion bacteriana asociada en Piel Normal Fria, poco turgente Fria, acrocianosis, signo neonatos de? Para valorar infeccion ventilacion mecanica es mayor en pacientes con enfermedad cardiaca o bacteriana. La sobreinfec necesaria en la evaluacion rutinaria de Microbiologia cion bacteriana pulmonar ocurre bronquiolitis(2,3), por lo que debe rea En general no se recomienda rea en aproximadamente un 1% de los lizarse solo si hay hallazgos sugestivos lizar test para agentes virales especifi ninos hospitalizados con bronquio de otros diagnosticos(1). Diagnostico al estrechamiento de la via aerea y a No obstante, existe un debate acerca de El diagnostico es clinico. La consolidacion si realizarlos modifica el manejo y los segmentaria y los infiltrados alveolares resultados del episodio(1), puesto que en fia de torax y la analitica pueden ayudar a descartar otras patologias.

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Improving the Nutritional Quality of of Severe Acute Malnutrition in Infants and Children cheap 500mg xeloda fast delivery pregnancy zumba. Guidelines for the Effectiveness of Community Based Management of Acute Inpatient Treatment of Severely Malnourished Children buy xeloda 500 mg fast delivery menstruation facts. Management of Severe and Moderate Acute Malnutrition in Children 223 Chapter 12 Infant and Young Child Growth Jai K 500 mg xeloda with amex womens health associates. The complex interplay ine growth and maternal interventions (balanced of social purchase 500 mg xeloda amex 45 menstrual cycle, economic, and political determinants of energy and micronutrient supplementation), nutri undernutrition results in substantial inequalities among tion interventions to improve infant and child feeding population subgroups (Black and others 2013). Bhutta, Robert Harding Chair in Global Child Health and Policy, the Centre for Global Child Health, the Hospital for Sick Children, Toronto, Canada, and Founding Director, Center of Excellence in Women and Child Health, Aga Khan University, Karachi 74800, Pakistan; zulfiqar. The later consequences of delayed motor, cognitive, and behavioral development; childhood malnutrition also include diminished intellec diminished immunity; and increased morbidity and tual performance, low work capacity, and increased risk mortality (Black and others 2013). Deficiencies of vitamin A and zinc adversely affect child health and survival; deficiencies of iodine and iron the determination of child nutrition status starts before can, together with causing stunting, limit the ability of birth; maternal nutritional status and fetal growth restric children to realize their developmental potential. Fetal growth Mortality and Morbidity restriction, in turn, is an important contributor to stunt Black and others (2013) demonstrate that all degrees of ing and wasting in children; approximately 20 percent stunting, wasting, and underweight are associated with of childhood stunting could have its origins in the fetal increased hazards of death from diarrhea, pneumonia, period (Black and others 2013). Undernutrition can measles, and other infectious diseases, with the excep only be tackled through a multipronged approach with tion of malaria; this analysis confirms the complex inter involvement of relevant sectors other than health. In addition approach was highlighted in the undernutrition series in to anthropometric measures, the association between the Lancet (Black and others 2013). The series underscores micronutrient deficiencies, such as vitamin A deficiency, that nutrition specific interventions can only reduce the and the increased risk of childhood infections and current burden of undernutrition by a fraction; a more mortality is well established (Black and others 2013). Other micronutrient water and sanitation, and health and family planning deficiencies, such as zinc and iron deficiencies, are wide services. Pregnancy is a state of higher metabolic dow of feeding within the first hour after birth is weak requirements, and both macronutrients and micronu (Edmond and others 2006; Mullany and others 2008). More modest improvements were observed clean and nutrient dense additional foods introduced in South Asia, where the prevalence increased from at age six months and typically provided until age 40 percent in 1995 to 45 percent in 2010. Meta analyses have shown an overall lead to increased dietary intake and growth of infants. Educational messages should be clear and should is supplemented alone compared with when it is admin include the promotion of nutrient rich animal products. The effect is also more pronounced for children need to be combined with food provision or use of with baseline stunting (Umeta and others 2000). Approximately 100 million Ramakrishnan, Nguyen, and Martorell (2009) analyzes women of reproductive age have iodine deficiencies, and data from 17 studies and finds no statistically significant an estimated 82 percent of pregnant women worldwide effect of vitamin A on growth. Iron defi of vitamin A supplementation on height gain (Awasthi ciencies are widespread; about 1. South Asia Iron and Sub Saharan Africa have the highest prevalence of the proportion of all childhood anemia corrected all iron deficiency anemia, and Sub Saharan Africa has by iron supplementation ranges from 63 percent in the highest prevalence of severe iron deficiency anemia Europe to 34 percent in Sub Saharan Africa. The findings also and evidence of increased diarrhea, suggesting further suggest that intermittent iron supplementation could be consideration is needed before large scale implementa a viable public health intervention in settings in which tion (Salam and others 2013). There is no convincing evidence that iron impact of nutrition sensitive interventions is limited, treatment has an effect on the mental development of they have huge potential. These strategies can be delivered through health systems, agriculture based programs, market based approaches, or other community based platforms. These Consensus has emerged on the importance of improved approaches include education, dietary modification, food water supply and excreta disposal for prevention of provision, agricultural interventions, supplementation, diseases, especially diarrheal diseases. Food and clean water, as well as enhanced facilities for excreta fortification can be a potentially cost effective pub disposal and promotion of hygiene, not only aim to lic health intervention and target a larger population improve the quality of life, but also help reduce the through a single strategy. A meta analysis of multiple incidence of infectious diseases, particularly in chil micronutrient fortification in children shows an dren. Although geographic disparities exist, rural and serum levels (retinol increase of 3. Interventions for water quality were associated that community health workers are able to implement with a 42 percent relative reduction in diarrhea morbidity many of these projects at scale, and they have substan in children younger than age five years, whereas those for tial potential to improve the uptake of child health and water supply had no significant effects. It is important to underscore the crucial reduction in childhood diarrhea morbidity, and hygiene importance of community engagement and buy in to interventions led to a 31 percent reduction. Subgroup ensure effective community outreach programs, behav analysis suggests that provision of soap with education ior change, and access (chapter 14 in this volume, [Lassi, was more effective than education only. These interventions include the following: Financial Incentives Financial incentives are increasingly used as policy. Periconceptional folic acid supplementation or strategies to counter poverty, reduce financial barriers, fortification and improve population health. Preventive zinc and vitamin A supplementation to be achieved by programs that directly removed user. Some indication of effect was noted for programs that conditioned finan Scaling up these identified interventions to 90 percent cial incentives on participation in health education and coverage could reduce deaths among children younger attendance at health care visits. Community Based Programs A full spectrum of promotive, preventive, and cura tive interventions to improve child nutrition can be Geographic Disparities delivered via community platforms. Within countries, wide disparities exist Promotion of breastfeeding between the richest and poorest wealth quintiles; in Appropriate complementary feeding 20 percent of the Countdown countries, more than Treatment for moderate acute 50 percent of the children in the poorest 20 percent of malnutrition all families is stunted. Implementation of tion, strong emphasis should be focused on improving an evidence based communication strategy using maternal nutrition even before pregnancy so that women multiple channels, connecting and coordinating the enter pregnancy in the optimal state of health and nutri efforts at the three levels, is also vital for the successful tion. Meeting the minimum direct determinants of nutrition and growth, including required dietary quality is a challenge in many coun diet, behavior, and health. Children indirect determinants such as food security, educa may not receive complementary foods at the right age, tion, environment, economic and social conditions, may not be fed frequently enough during the day, resources, and governance. A comprehensive bating malnutrition requires a multifaceted approach approach includes both counseling for caregivers on involving both the interventions directed at the more the best use of available foods (both local and com immediate causes of suboptimum growth and develop mercially available) and feeding and care practices, ment (nutrition specific) and the large scale nutrition and the provision of micronutrient and food supple sensitive programs that broadly address the underlying ments, when needed.

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Febrile respiratory illness this term is used to buy 500 mg xeloda mastercard menstrual issues describe a wide range of droplet and contact spread respiratory infections buy cheap xeloda 500 mg women's health center in lansdale, which usually present with symptoms of a fever > 38?C and new or worsening cough or shortness of breath buy xeloda 500mg online menstrual insomnia. Neonates purchase xeloda 500 mg menstruation nation bobs burgers, the elderly, and those who are immunocompromised may not have fever in association with a respiratory infection. Fit testing Fit testing is the use of a qualitative or a quantitative method to evaluate the ft of a specifc manufacturer, model and size of respirator on an individual. Fomites Fomites are inanimate objects in the environment that may become contaminated with microorganisms and serve as vehicles of transmission. Hand antisepsis this is a process for the removal or killing of transient microorganisms on the hands, using an antiseptic. It is also referred to as antimicrobial or antiseptic handwash, antiseptic hand rubbing, disinfection or decontamination. Hand care program A hand care program for staff is a key component of hand hygiene and includes hand care assessment, health care worker education, occupational health assessment if skin integrity is an issue, provision of hand moisturizing products and provision of alcohol based hand rub that contains an emollient. Hand hygiene this is a comprehensive term that applies to hand washing, hand antisepsis and to actions taken to maintain healthy hands and fngernails. The design of a hand hygiene sink includes the placement of soap and towel dispensers and a garbage can. A washroom sink or other sink that is used for general purposes is not a hand hygiene sink. Hand hygiene sinks shall be dedicated to that purpose and not used for any other purpose. Hand washing Hand washing is a process for the removal of visible soil and organic material and transient microorganisms from the hands by washing with soap and water. Hand washing sink See designated hand washing sink for health care workers and hand hygiene sink. Health care environment this refers to the people and items which make up the care environment. Prehospital care this is acute emergency patient assessment and care delivered in a variety of settings. Prehospital care workers may include paramedics, fre fghters, police and other emergency frst responders. Acute care defnition: this refers to a facility where a variety of inpatient services are provided, which may include surgery and intensive care. For the purpose of this document, acute care also includes ambulatory care settings such as hospital emergency departments, and free standing ambulatory (day) surgery or other invasive day procedures. Ambulatory care defnition: this refers to a location where health services are provided to patients who are not admitted to inpatient hospital units, including outpatient diagnostic and treatment facilities. Long term care this refers to a facility that includes a variety of activities, types and levels of skilled nursing care for individuals requiring 24 hour surveillance, assistance, rehabilitation, restorative or medical care in a group setting that does not fall under the defnition of acute care. Home care Home care is the delivery of a wide range of health care and support services to patients in a variety of settings for health restoration, health promotion, health maintenance, respite, palliation and to prevent or delay admission to long term patient care. Health care providers Any person delivering care to a client/patient/resident is a health care provider. In some non acute settings, volunteers might provide care and would be included as health care providers. Immunocompromised this term refers to patients with congenital or acquired immunodefciency or immunodefciency due to therapeutic agents or hematologic malignancies. Infectious agent this terminology is used to describe a microorganism or a pathogen capable of causing diseases (infection) in a source or a host. Infuenza like illness this refers to a constellation of symptoms, which may be exhibited by individuals prior to the confrmation of infuenza. Inoculum size this refers to the number of microorganisms transmitted to the host. Mask A mask is a barrier to prevent droplets from an infected source from contaminating the skin and mucous membranes of the nose and mouth of the wearer, or to trap droplets expelled by the wearer, depending on the intended use. The mask should be durable enough so that it will function effectively for the duration of the given activity. The term mask in this document refers to surgical or procedure masks, not to respirators. Mode of transmission Mode of transmission is the mechanism by which an infectious agent is spread. N95 respirator the N95 is a disposable, particulate respirator (Note: most respirators used for health care purposes are disposable fltering face pieces, covering the mouth, nose and chin). Airborne particles are captured from the air on the flter media by interception, inertial impaction, diffusion and electrostatic attraction. The flter is certifed to capture at least 95 per cent of particles at a diameter of 0. Natural ventilation this refers to the use of natural forces to introduce and distribute outdoor air into a building. These natural forces can be wind pressure or pressure generated by the density difference between indoor and outdoor air. Non critical items these are items that touch only intact skin, but not mucous membranes. Reprocessing of non critical items involves thorough cleaning and/or low level disinfection. Occupational health For the purposes of this document, this phrase refers to the disciplines of occupational health medicine and nursing, occupational hygiene and occupational health and safety.

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On the Micro and Macronutrients Related to cheap xeloda 500mg online menstrual cramps 9 days before period Chronic Respiratory Diseases contrary generic 500 mg xeloda women's health liposlim, the Western? dietary pattern (characterized by high consumption of refined grains 500 mg xeloda mastercard the women's health big book of exercises pdf download, cured and red meats order 500mg xeloda visa menopause kills marriages, desserts and Pregnant women (hence, their babies) and children under 5 years of sweets, french fries, and high fat dairy products) has been associated age are particularly vulnerable to micronutrient deficiency, increasing to obesity and increased risk of asthma in children. In addition, multiple micronutrient deficiencies coexist in the same Observational studies on vitamin D in children with asthma have individuals. Vitamin A deficiency is related to impaired immune shown a strong relationship between low levels of vitamin D and function and cell differentiation. Zinc deficiency has been associated with a higher incidence of acute respiratory infections, a major cause of death in children under 5 years Over nutrition and resulting obesity are clearly linked with respiratory in developing countries [1]. Obese children with asthma have a decreased lung function, reduced response to inhaled corticosteroids, Instead, nutritional interventions or diets rich in fruits and vegetables lower quality of life and higher morbidity. A recent meta analysis on the effect of reported that obesity is associated with airway dysanapsis, which is childhood nutrient intake and the risk of developing wheezing or associated with severe disease exacerbations in obese children with asthma showed that there was some evidence of protective effects asthma [10]. In the obese state, several causal mechanistic pathways from Vitamin A, D and E, zinc, fruit and vegetables, and of a have been reported: anatomical changes of airway, circulating free Mediterranean diet against the development of asthma [2]. Also, fatty acids which activate immune responses leading to increased Saadeh et al. It has Inadequate growth, weight gain and malnutrition are well recognized a well established immunomodulatory effect within the lung. Given the fact that nutrition plays an important miological studies show significant associations between vitamin D role in lung development and maturation, specific nutritional and several acute and chronic lung diseases such as asthma. This results in a negative energy asthma and high intake of omega 6 Long chain polyunsaturated fatty balance which leads to malnutrition. Maternal dietary intake of oily fish was recurrent infections and hospitalizations. Therefore, an adequate found to be protective of asthma in children 5 years of age if born to nutritional intervention is essential to match the increased energy mothers with asthma. In asthma, dietary exposures (nutrients and diet), and the hyperoxia induced injury or improve alveolar development. However, periods of introduction (antenatal or childhood) are relevant to disease evidence for supplementation is still controversial for most of these pathogenesis. Current reduced maternal consumption of some micronutrients and childhood evidence shows that supplementation of vitamin A and omega 3 asthma. Poor nutrition leads to poor lung intake are associated withimproved asthma control. Bracken, Childhood body mass malnutrition in early life is related to imparted lung function during index and subsequent physician diagnosed asthma: a systematic review childhood [13]. These deficiencies may also increase susceptibility to respiratory infections without Asthma. Also, poor adherence to pancreatic enzymes has been early childhood is associated with improved clinical outcomes and survival related to difficulties in correcting malabsorption, hence, worst in patients with cystic fibrosis. Black, the epidemiology of global neonatalperiod,and anadditional 125,000deathsinchildren agedone micronutrient deficiencies. Sheikh, Nutrientsand foodsfor the infants, with increased risk of cerebral palsy, impaired learning and primary prevention of asthma and allergy: systematic review and meta visual disorders, and chronic/recurrent respiratory diseases that start analysis. Zosky, Vitamin D deficiency and the lung: disease Currently, 80% of infants born with weights between 500 and 750 g initiator or disease modifier? Mozurkewich, the effect of gestational age at tertiary centers will survive to 5 years of age. Another series of preterm infants born less than of asthma, wheeze, and atopic diseases during childhood: a systematic 32 weeks of gestational age showed that 25% were hospitalized in the review and meta analysis. Rehospitalization in the pulmonarysystems ofpretermnewbornbabies,influencingthenormal first 2 years of life in children born preterm. Acta Paediatr 2012;101 development of the respiratory tract, and consequently both the (1):e1 e5 process of alveolar growth, and formation of an adequate pulmonary 5. The risk for respiratory morbidity is inversely six year follow up of clinical hyaline membrane disease. Pediatr Clin associated with birth weight (which is dependent of gestational age North Am. A long list of pulmonary findings in children born preterm include Respiratory health in a total very low birthweight cohort and their increased incidence of pneumonia and bronchiolitis (5) frequent re classroom controls. Bronchial ability and coughing and wheezing, bronchial hyperreactivity (7) and pulmonary responsiveness in school children born very preterm. Altered lung structure and function in mid childhood In a recent meta analysis over 1. Thorax 2016 analyzed for the chance of wheezing in the first years of life and preterm birth was found to be an independent associated variable 10. In the subgroup of very low birth wheezing disorders: a systematic review and meta analysis. Respiratory syncytial virus and recurrent wheeze in healthy early life interventions that may attenuate the severity of these preterm infants. A recent double blind placebo controlled trial has shown that treatment with Palivizumab has #3. Zar Dept of Paediatrics and Child Health 5th in most settings) for babies born prematurely. Clinical scoring systems, to be even greater than that observed in more affluent societies. Outcome at 5 years of age of children of 23 to 27 weeks strategies to promote better specimen collection, including induced gestation: refining the prognosis.

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