Asunción Mejías - Academia.edu (original) (raw)

Papers by Asunción Mejías

Principles and Practice of Pediatric Infectious Diseases

This article cites 53 articles, 25 of which can be accessed free

Pediatric Allergy and Immunology, 2019

Background. Data addressing short-and long-term respiratory morbidity in moderate-late preterm in... more Background. Data addressing short-and long-term respiratory morbidity in moderate-late preterm infants is limited. We aim to determine the incidence of recurrent wheezing and associated risk and protective factors in these infants during the first 3 years of life. Methods. Prospective, multicenter birth cohort study of infants born at 32 +0 to 35 +0 weeks' gestation and followed for 3 years to assess the incidence of physician-diagnosed recurrent wheezing. Allergen sensitization and pulmonary function were also studied. We used multivariate mixed-effects models to identify risk factors associated with recurrent wheezing. Results: 977 preterm infants were enrolled. Rates of recurrent wheezing during year (Y)1 and Y2 were similar (19%) but decreased to 13.3% in Y3. Related hospitalizations significantly declined from 6.3% in Y1 to 0.75% in Y3. Independent risk factors for recurrent wheezing during Y2 and Y3 included: day care attendance, acetaminophen use during pregnancy and need for mechanical ventilation. Atopic dermatitis on Y2 and male sex on Y3 were also independently associated with recurrent wheezing. Palivizumab prophylaxis for RSV during the first year of life, decreased the risk or recurrent wheezing on Y3. While there were no differences in rates of allergen sensitization, pulmonary function tests (FEV 0.5) were significantly lower in children who developed recurrent wheezing. Conclusions. In moderate-to-late premature infants, respiratory symptoms associated with lung morbidity persisted during the first 3 years of life and were associated with abnormal pulmonary function tests. Only anti-RSV prophylaxis exerted a protective effect in the development of recurrent wheezing.

Anales de Pediatría (English Edition), 2018

Research is the cornerstone of medical progress. Paediatric research has its own nuances and repr... more Research is the cornerstone of medical progress. Paediatric research has its own nuances and represents an additional challenge due to the intrinsic characteristics of the paediatric population compared with adults. Despite the tremendous importance of childhood health and its impact during adulthood, society is still not convinced about the importance of conducting research in paediatrics. This also applies to paediatricians themselves, who think about research as a discipline that does not directly involve them. The Spanish Academy of Paediatrics has developed a specific research platform-INVEST-AEPto try to help and answer the challenges associated with paediatric research in the society. This article reflects the current status of paediatric research in Spain, and the goals achieved over the last few years due to the effort of paediatric researchers. In addition, a deeper analysis is provided as regards: (a) the barriers that represent a hurdle for the development of broad and competitive paediatric research in our day to day work; (b) the limited incentives and specific preand post-doctoral training; (c) the high clinical burden for paediatricians or; (d) the lack of specific infrastructure and dedicated funding for paediatrics. The mission, vision and values of INVEST-AEP are to develop an accessible roadmap for the development and implementation of paediatric research in Spain for the next few years.

Frontiers in Cellular and Infection Microbiology, 2016

Background: Helicobacter pylori infects half of the world's population and causes gastric cancer ... more Background: Helicobacter pylori infects half of the world's population and causes gastric cancer in a subset of infected adults. Previous blood microarray findings showed that apparently healthy children, persistently infected with H. pylori have differential gene expression compared to age-matched, non-infected children. SLC5A8, a cancer suppressor gene with decreased expression among infected children, was chosen for further study based on bioinformatics analysis. Methods: A pilot study was conducted using specific qRT-PCR amplification of SLC5A8 in blood samples from H. pylori infected and non-infected children, followed by a larger, blinded, case-control study. We then analyzed gastric tissue from H. pylori infected and non-infected children undergoing endoscopy for clinical purposes. Results: Demographics, clinical findings, and family history were similar between groups. SLC5A8 expression was decreased in infected vs. non-infected children in blood, 0.12 (IQR: 0-0.89) vs. 1.86 (IQR: 0-8.94, P = 0.002), and in gastric tissue, 0.08 (IQR: 0.04-0.15) vs. 1.88 (IQR: 0.55-2.56; P = 0.001). Children who were both stool positive and seropositive for H. pylori had the lowest SLC5A8 expression levels. Conclusions: H. pylori infection is associated with suppression of SCL5A8, a cancer suppressor gene, in both blood and tissue samples from young children.

Pediatric Infectious Disease Journal, 2016

W e appreciate the comments by Büyükkapu et al on our published article on the clinical outcome o... more W e appreciate the comments by Büyükkapu et al on our published article on the clinical outcome of infections caused

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, Jan 2, 2015

Helicobacter pylori, the main cause of peptic ulcer disease and gastric cancer in adult populati... more Helicobacter pylori, the main cause of peptic ulcer disease and gastric cancer in adult populations, is generally acquired during the first years of life. Infection can be persistent or transient and bacterial and host factors determining persistence are largely unknown and may prove relevant for future disease. Two cohorts of healthy Chilean infants (313 total) were evaluated every three months for 18-57 months to determine pathogen- and host-factors associated with persistent and transient infection. One-third had at least one positive stool ELISA by age three, with 20% overall persistence. Persistent infections were acquired at an earlier age, associated with more household members, decreased duration of breastfeeding, and non-secretor status compared to transient infections. cagA positive strains were more common in persistent stools, and nearly 60% of fully-characterized persistent stool samples amplified cagA/vacAs1m1. Persistent children were more likely to elicit a serolo...

Treatments in Respiratory Medicine, 2006

R espiratory syncytial virus (RSV) usually causes cold-like symptoms but can also cause more seve... more R espiratory syncytial virus (RSV) usually causes cold-like symptoms but can also cause more severe diseases, such as pneumonia and bronchiolitis. Bronchiolitis, an inflammation of the small airways in the lung with increased mucus production and bronchospasms (contraction and relaxation of the small airways), most often occurs in children younger than 2 years. In children, RSV infections may start out with fever, mild cough, and congestion. This can lead to worsening cough and labored and rapid breathing that interfere with the ability to eat and drink. In the United States, RSV infections usually occur between November and May but may occur earlier in the year in some areas. The infection spreads by contact with an infected person's saliva and mucus containing the virus.

Current Topics in Microbiology and Immunology, 2013

The Pediatric Infectious Disease Journal, 2004

Advertisement. Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Th... more Advertisement. Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for The Pediatric Infectious Disease Journal. Enter your Email address: Wolters Kluwer Health may email you for journal alerts and ...

Pediatric Annals, 2005

Better therapies and prevention strategies are needed to decrease the burden of acute RSV disease... more Better therapies and prevention strategies are needed to decrease the burden of acute RSV disease in all age populations worldwide. Furthermore, we can hypothesize that those improved measures also would likely have an effect on the chronic consequences of RSV infection in children and will reduce the incidence of recurrent wheezing and persistent pulmonary function abnormalities caused by RSV LRIs.

Genomic and Personalized Medicine, 2013

Traditional microbiologic diagnostic tests relied on laboratory identification of the pathogen ca... more Traditional microbiologic diagnostic tests relied on laboratory identification of the pathogen causing the infection. However, this approach is less than optimal for a variety of reasons: pathogen’s slow growth, resistance to cultivation in vitro or insufficient proof to establish causality when a pathogen is identified. An alternative approach to the pathogen-detection strategy is based on a comprehensive analysis of the host response to the infection by analysis of blood leukocytes gene expression profiles. This strategy has been successfully applied to distinguish and classify children and adults with acute infections caused by different pathogens.

The Pediatric Infectious Disease Journal, 2008

FIGURE 1. Voriconazole serum concentrations. (F) ϭ serum trough value; (ࡗ) serum peak concentrati... more FIGURE 1. Voriconazole serum concentrations. (F) ϭ serum trough value; (ࡗ) serum peak concentration; (OE) serum mid value; (.. . .) therapeutic window; (O) dosage in milligrams.

The Pediatric Infectious Disease Journal, 2014

Background: The rates of isoniazid (INH) and multidrug-resistant (MDR) tuberculosis (TB) among Eu... more Background: The rates of isoniazid (INH) and multidrug-resistant (MDR) tuberculosis (TB) among European children vary between 10.4% and 3.5%. Spain is a low endemic country with reported rates of 4.9% of INH resistance and 1.3% of MDR in adults. However, data regarding patterns of TB resistance in children are scarce. Our aim is to determine the incidence and risk factors for pediatric-resistant TB in our setting to help developing agetargeted guidelines. Methods: A multicenter, retrospective study including 22 hospitals from Madrid region (EREMITA study group) was performed from January 2005 to June 2010. Medical records from children diagnosed with TB were reviewed for demographic characteristics, clinical presentation and outcomes. Risk factors for INH and MDR TB were identified. Results: Of 396 children diagnosed with TB, 72.4% were born to foreign parents. Microbiologic confirmation by culture (n = 200) or PCR (n = 8) was documented in 208 children (52.5%). Drug susceptibility results were available in 188 children: 9.6% (n = 18) were resistant to INH and 3.1% (n = 6) were MDR. INH resistance was more common in immigrants compared with native families (11.9% vs. 0%; P = 0.013), as was also MDR (4.5% vs. 0%; P = 0.34). Extrapulmonary TB and previous antituberculous treatment were significantly associated with INH and MDR, while immunosuppression was associated only with MDR. Conclusions: The rates of INH and MDR TB were different according to the parents' origin, with higher rates among children born to foreign parents. Local surveillance of drug-resistant TB is critical to develop appropriate guidelines for treatment.

The Pediatric infectious disease journal, 2008

Several studies have described a clear association between respiratory syncytial virus (RSV) lowe... more Several studies have described a clear association between respiratory syncytial virus (RSV) lower respiratory tract infection in infancy and the subsequent development of persistent wheezing in children. Using the mouse model we demonstrated that RSV induces long-term airway disease characterized by chronic airway inflammation and airway hyperreactivity (AHR). The RSV murine model offers great advantages to study the immunopathogenesis of RSV-induced long-term airway disease. Mice can be challenged with aerosolized methylcholine to determine the presence of AHR. We can apply the reverse transcription-polymerase chain reaction assay (RT-PCR) to detect RSV RNA in the respiratory tract and we can perform lung gene expression analysis to further characterize the chronic changes induced by RSV infection. Compared with sham-inoculated controls, RSV-infected mice developed chronic airway disease characterized by AHR and persistent airway inflammation. Forty-two days after RSV infection, a...

The Pediatric infectious disease journal, 2010

The role of respiratory viruses in the pathogenesis of Kawasaki disease (KD) remains controversia... more The role of respiratory viruses in the pathogenesis of Kawasaki disease (KD) remains controversial. In this study, we showed that 8.8% of patients with KD had documented respiratory viral infections. Patients with concomitant viral infections had a higher frequency of coronary artery dilatations and were significantly more often diagnosed with incomplete KD. The presence of a concomitant viral infection should not exclude the diagnosis of KD.

The Pediatric infectious disease journal, 2012

The burden of tuberculosis (TB) after pediatric solid organ (SOT) or hematopoietic stem cell tran... more The burden of tuberculosis (TB) after pediatric solid organ (SOT) or hematopoietic stem cell transplantation (HSCT) has not been well characterized. We report 7 pediatric cases with disseminated (4/7) or pulmonary (3/7) TB after SOT (n=6) or HSCT (n=1) during 26 years. The outcome was favorable in 6 patients. Isoniazid-induced hepatitis and rifampin interactions were common.

Journal of Perinatology, 2009

Objective: The significance of detecting herpes simplex virus (HSV) DNA in the cerebrospinal flui... more Objective: The significance of detecting herpes simplex virus (HSV) DNA in the cerebrospinal fluid (CSF) of infants with HSV encephalitis after receipt of prolonged therapy with high-dose (60 mg kg À1 day À1) acyclovir is unknown. We report the clinical and laboratory characteristics, neuroimaging studies and outcomes of four neonates with HSV encephalitis who had persistence of CSF HSV DNA, by polymerase chain reaction (PCR) after 15 to 21 days of high-dose acyclovir therapy. Study Design: Retrospective chart review. Results: All four infants had abnormal neuroimaging studies and subsequently experienced severe developmental delay or death. Conclusion: A persistently positive CSF HSV PCR in neonates may be another risk factor for worse neurodevelopmental outcome. Prospective studies are needed to document how often HSV DNA persists in CSF, elucidate whether it represents an initially high CSF viral load, ongoing viral replication or viral resistance, and determine its possible association with neurodevelopmental impairment.