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Background Community-acquired pneumonia (CAP) represents a major cause of hospitalization, especially among young children. In the third world countries, information about CAP etiology is scarce. Therefore, rapid and highly sensitive diagnostic methods are crucial to determine etiologic agents. Methods Between March 2016 and March 2017, we have prospectively studied the clinical, radiologic, laboratory, and molecular aspects of patients with CAP at 2 tertiary-level hospitals in Santa Cruz de la Sierra, using a multiplex real-time polymerase chain reaction (RT-PCR). Results A total of 274 children were evaluated, with a median age of 13 months. An etiologic agent was identified in 187 patients (68.2%): 54% (n = 148) were viruses and 14.2% (n = 39) were bacteria. CAP prevalence was highest among children under 2 years (71%; 195/274); respiratory syncytial virus (RSV) was the most frequent cause in 22% (60/274), especially among infants, followed by influenza (14.5%; 40/274). Streptococcus pneumoniae accounted for 7% of the total (19/274), followed by Staphylococcus aureus (3%;8/274) and Haemophilus influenzae (1.4%;4/274). Together, these cases accounted for 79.5% (31/39) of all bacterial CAP. Pleural effusion (PE) complicated CAP in 13.8% (38/274), of which 29 were of bacterial etiology. RT-PCR increased the detection rate of pneumococcus by 47%. Coinfection occurred in 28 patients (10%); 26 (9.5%) required intensive care and 9 patients (3%) died. Conclusions RT-PCR provided additional diagnostic value to conventional, clinical, and laboratory methods. The higher prevalence of RSV, influenza, and Streptococcus pneumoniae reveals the need for preventive measures with better vaccine uptake and future research for RSV vaccines.

Subacute osteomyelitis has a very anodyne symptomatology and is, therefore, difficult to diagnose. We studied 21 cases treated between 1984 and 1998 with subacute osteomyelitis of variable location and a mean diagnostic delay of 158.5 days. Of these, 10 cases could not be placed in the current classification. Diagnosis was radiologic in all cases, although in a few patients confirmation by isotopic bone scan and magnetic resonance imaging was required. Treatment was surgical in the first 11 cases to become, currently, predominantly conservative. The causal microorganism was only isolated in nine cases. Complete healing without sequelae was achieved in all but one case, which was of very tardy diagnosis and developed coxarthrosis.

Seven cases of premature physeal closure secondary to diaphyseal fractures of the tibia in adolescents between 12 and 15 years of age are presented. At the time of the accidents, there was no evidence of physeal lesion in any of the patients. After 4 to 13 months of follow-up (mean, 9 months), early closure was observed in the radiologic controls of one or more physes of the affected leg: distal femoral and proximal and distal tibial in three cases, isolated distal femoral physis in three cases, and both tibial physes without femoral damage in one case. Physeal closure was always central, and there was no case of angular deformity. After 15 to 42 months of follow-up (mean, 27 months), all patients had a leg-length discrepancy in the 8- to 30-mm range (mean, 18 mm). Only one patient required surgical correction (proximal epiphysiodesis of the contralateral tibia followed by tibial lengthening). Adolescents with diaphyseal fractures of the long bones should be monitored until they have stopped growing because of the risk of developing leg-length discrepancy as a consequence of premature closure of one or more leg physis.

The results of three different surgical procedures for the correction of bunions on 25 adolescent feet (distal soft-tissue procedure, proximal closing-wedge osteotomy of the first metatarsal with distal soft-tissue procedure, and proximal phalangeal osteotomy) are reviewed. The results with an average follow-up of 3.5 years were excellent or good in 21 cases, and fair or poor in 4. The average correction of the metatarsophalangeal angle, the intermetatarsal angle, and the hallux valgus interphalangeus angle was, respectively, 9.88, 3.11, and 0.0 degrees for the first procedure, 21.0, 6.87, and 0.0 degrees for the second, and 11.0 0.9, and 22.5 degrees for the third. We conclude that distal soft-tissue reconstruction allows only mild to moderate correction of the metatarsophalangeal and intermetatarsal angles, and the association of a proximal osteotomy of the first metatarsal produces an statistically significant better correction (p < 0.05). Hallux valgus interphalangeus deformities are corrected only by proximal phalanx osteotomies. The selection of a particular procedure should therefore be based on an appropriate preoperative planification.

Between 1985 and 1996, our Service treated 18 cases of osteochondritis dissecans of the talus in children and adolescents. The lesion is more frequent during childhood than previously thought. Different theories about the etiology of the lesion and the various treatments used are discussed. The outcome was satisfactory in most cases. We consider that, with the exception of type IV Berndt and Harty lesions, preliminary treatment should be conservative, which gave good results in our study. Surgical treatment should be reserved for patients with an unsatisfactory evolution with orthopaedic treatment, with lesions with thick sclerotic edges, or for patients with loose intraarticular fragments.