Setting priorities for an agenda within the Spanish pediatric emergency medicine research network.

The research network of the Spanish Pediatric Emergency Society (RISeuP-SPERG Network) needs to establish its research agenda relevant to pediatric emergency medicine (PEM) to guide the development of future projects, as other networks have done before. The aim of our study was to identify priority areas in PEM for a collaborative network of pediatric emergency research in Spain. A multicenter study was developed including pediatric emergency physicians from 54 Spanish emergency departments, endorsed by the RISeuP-SPERG Network. Initially, a group of seven PEM experts was selected among the members of the RISeuP-SPERG. In the first phase, these experts elaborated a list of research topics. Then, using a Delphi method, we sent a questionnaire with that list to all RISeuP-SPERG members, to rank each item using a 7-point Likert scale. Finally, the seven PEM experts, using a modified Hanlon Process of Prioritization, weighted prevalence (A), seriousness of the condition (B), and feasibility of conducting research projects (C) on that condition to prioritize the selected items. Once the list of topics was chosen, the seven experts selected a list of research questions for each of the selected items. The Delphi questionnaire was answered by 74/122 (60.7%) members of RISeuP-SPERG. We established a list of 38 research priorities related to quality improvement (11), infectious diseases (8), psychiatric/social emergencies (5), sedoanalgesia (3), critical care (2), respiratory emergencies (2), trauma (2), neurologic emergencies (1), and miscellanea (4).   Conclusion: The RISeuP-SPERG prioritization process identified high-priority PEM topics specific to multicenter research that may help guide further collaborative research efforts within the RISeuP-SPERG network to improve PEM care in Spain. What is Known: • Some pediatric emergency medicine networks have established their priorities for research. What is New: • After a structured process, we have set the research agenda for pediatric emergency medicine in Spain. By identifying high-priority pediatric emergency medicine research topics specific to multicenter research, we may guide further collaborative research efforts within our network.

Invasive bacterial infection in children with fever and petechial rash in the emergency department: a national prospective observational study.

OBJECTIVE: To determine the incidence and clinical predictors of invasive bacterial infection (IBI) in well-appearing children who present to the emergency department (ED) with fever and petechiae. DESIGN: A prospective, observational, multicentre study was conducted in 18 hospitals between November 2017 and October 2019. PATIENTS: A total of 688 patients were recruited. MAIN OUTCOME MEASURES: The primary outcome was the presence of IBI. Clinical features and laboratory test results were described and related to the presence of IBI. RESULTS: Ten IBIs were found (1.5%), comprising eight cases of meningococcal disease and two of occult pneumococcal bacteraemia. Median age was 26.2 months (IQR 15.3-51.2). Blood samples were obtained from 575 patients (83.3%). Patients with an IBI had a shorter time from fever to ED visit (13.5 hours vs 24 hours) and between fever and rash onset (3.5 hours vs 24 hours). Values for absolute leucocyte count, total neutrophil count, C reactive protein and procalcitonin were significantly higher in patients with an IBI. Significantly fewer patients with a favourable clinical status while in the observation unit were found to have an IBI (2/408 patients, 0.5%) than when clinical status was unfavourable (3/18, 16.7%). CONCLUSIONS: The incidence of IBI among children with fever and petechial rash is lower than previously reported (1.5%). The time from fever to ED visit and to rash onset was shorter in patients with an IBI. Patients with a favourable clinical course during observation in the ED are at lower risk of IBI.

Agave pulquero (Agave salmiana), socio-economic and agro-ecological importance and its development perspectives: a literature review / Agave pulquero (Agave salmiana), importância socioeconômica e agroecológica e suas perspectivas de desenvolvimento: uma revisão da literatura

ABSTRACT: Historically, the agave pulquero (Agave spp.) has played an important ecological, economic, social, and cultural role in Mexico. Based on a systematic exploratory review of 125 scientific documents, four areas of knowledge associated with the study of agave pulquero were identified: i) biochemistry (46,4%), ii) socioeconomics (20%), iii) cultural studies (11,2%), and iv) agroecology (22,4%). Research converges on the need to value and preserve agaves since they can play an important role in rural development actions and the life quality of future societies, depending on the diversity of food, industrial, agro-ecological and cultural uses they provide. However, there is a fragmentary construction of the research problems that prevent a comprehensive vision of the producing territories as subjects of development. It is concluded that it is necessary to generate interdisciplinary perspectives for the valorization of the agave pulquero as an asset of rural development, based on inclusive innovation strategies, adapted to the specific needs of producers and consumers.

RESUMO: Historicamente, o agave pulquero (Agave spp.) tem desempenhado um importante papel ecológico, econômico, social e cultural no México. Com base em uma revisão exploratória sistemática de 125 documentos científicos, quatro áreas de conhecimento associadas ao estudo do agave pulquero foram identificadas: i) bioquímica (46,4%), ii) socioeconomia (20%), iii) estudos culturais (11, 2%) e iv) agroecologia (22,4%). A pesquisa converge para a necessidade de valorizar e preservar as agaves, uma vez que podem desempenhar um papel importante nas ações de desenvolvimento rural e na qualidade de vida das sociedades futuras, dependendo da diversidade de usos alimentícios, industriais, agroecológicos e culturais que proporcionam. No entanto, há uma construção fragmentária dos problemas de pesquisa que impedem uma visão abrangente dos territórios produtores como sujeitos de desenvolvimento Conclui-se que é necessário gerar perspectivas interdisciplinares para a valorização do agave pulquero como um ativo de desenvolvimento rural, baseado em estratégias de inovação inclusivas, adaptadas às necessidades específicas de produtores e consumidores.

Resultados del tratamiento con tubo de silicón en la dacrioestenosis del adulto / Results with silicone lacrimal tubes treatment in adults with acquired nasolacrimal duct obstruction

A lo largo de muchos años se ha intentado encontrar la mejor terapéutica para la dacrioestenosis, desde la irrigación y sondeo de la vía lagrimal hasta el uso de tubos de silicón. El objetivo de nuestro estudio fue definir la eficacia del uso de tubos de silicón en estos pacientes. Se realizó un estudio retrospectivo, en el que se incluyen pacientes adultos, con dacrioestenosis no traumática sometidos a dacriointubación cerrada con tubos de silicón.En un periodo de seguimiento de 10 meses de los 34 pacientes, 22 pacientes (64.70 por ciento), tuvieron un resultado posoperatorio eficaz y 12 pacientes (35.29 por ciento) tuvieron un resultado ineficaz. Las complicaciones posquirúrgicas que se tuvieron por el material de silicón fueron fístula en dos pacientes (5.88 por ciento) y desgarro del punto lagrimal en un paciente (2.94 por ciento). De acuerdo con la literatura nuestros resultados fueron similares.La dacriointubación cerrada ofrece la ventaja de permeabilizar la vía lagrimal de una manera natural, siendo un procedimiento recomendable antes de procedimientos más agresivos.