Impact of an influenza vaccine educational programme on healthcare personnel.

Influenza vaccination has been shown to be the most effective preventive strategy to reduce influenza-related morbidity and mortality in high-risk groups. Despite healthcare personnel (HCP) being considered part of such high-risk groups, their vaccination coverage is low in Europe. In January 2012, we distributed an 18-question survey regarding influenza vaccination to HCP at Gregorio Marañon Paediatric Hospital, in Madrid, Spain. After we documented that only ~30% of HCP were vaccinated an educational programme was implemented in October 2012 before the next influenza season. In January 2013, the same survey delivered again to all HCP documented a significant increase in vaccination rates (from 30% to 40%, P = 0·007) mainly among physicians and for patients' protection. In summary we found that a simple and inexpensive educational programme significantly improved the uptake of influenza vaccination in HCP in our centre. Nevertheless, vaccination rates remained low, and broader and updated campaigns are needed to overcome perception barriers.

Respiratory syncytial virus: A new era.

Respiratory syncytial virus (RSV) is a major public health problem that has undergone significant changes in recent years. First of all, it has become easier to diagnose with highly reliable and rapidly available confirmatory tests. This has led to a better understanding of its epidemiology and RSV has gone from being a disease of the pediatric age group, severe only in infants and immunosuppressed children, to being a common disease in people of all ages, particularly important in patients of advanced age or with immunosuppressive diseases. Recent therapeutic and prophylactic advances, both with long-lasting monoclonal antibodies and vaccines, are another reason for satisfaction. For these reasons, the COVID and Emerging Pathogens Committee of the Illustrious Official College of Physicians of Madrid (ICOMEM) has considered it pertinent to review this subject in the light of new knowledge and new resources for dealing with this infection. We have formulated a series of questions that we believe will be of interest not only to members of the College but also to any non-expert in this subject, with a particular focus on the situation of RSV infection in Spain.

[Impact of the "daily huddle" on the safety of pediatric hospitalized patients]. / Impacto de los «daily huddle¼ en la seguridad del paciente pediátrico hospitalizado.

INTRODUCTION: In 2017, the Joint Commission proposed daily meetings called "huddle" as an indicator of quality of care. They are brief daily meetings of the multidisciplinary team, where security problems of the last 24h are shared and risks are anticipated. The objectives were to describe the most frequent safety events in Pediatric wards, implement improvements in patient safety, improve team communication, implement international safety protocols, and measure the satisfaction of the staff involved. MATERIAL AND METHODS: Prospective, longitudinal and analytical design (June 2020-February 2022), with previous educational intervention. Safety incidents, data related to unequivocal identification, allergy and pain records, data from the Scale for the Early Detection of Deficiencies (SAPI) and the Scale for the Secure Transmission of Information (SBAR) were collected. The degree of satisfaction of the professionals was evaluated. RESULTS: Three hundred forty-eight security incidents were recorded. Medication prescription or administration errors stood out (n=103). Drug prescription or administration errors stood out (n=103), especially those related to high-risk medication: acetaminophen (n=14) (×10 doses of acetaminophen; n=6), insulin (n=6), potassium (n=5) and morphic (n=5). An improvement was observed in the pain record; 5% versus 80% (P<.01), in the SAPI registry 5% versus 70% (P<.01), in SBAER scale 40% vs 100% (P<.01), in unequivocal identification of the patient 80% versus 100%; (P<.01) and in the application of analgesic techniques 60% versus 85% (P=.01). In the survey of professionals, a degree of satisfaction of 8 (7-9.5)/10 was obtained. CONCLUSIONS: Huddles made it possible to learn about security events in our environment and increase the safety of hospitalized patients, and improved communication and the relationship of the multidisciplinary team.

First Report of Powdery Mildew on Carrot Caused by Erysiphe heraclei in Michoacan, Mexico.

Carrot (Daucus carota L. subsp. sativus (Hoffm.) Arcang.) is planted as a home-grown vegetable in the central region of Michoacan, Mexico. Powdery mildew was observed on carrot plants cv. Nantesa at several locations near Morelia, Michoacan during March 2009. Affected plants had abundant, white, superficial conidia and mycelium on leaves and stems. All plants at each of five locations surveyed had powdery mildew symptoms with percent foliage coverage ranging from 50 to 80%. Mycelial growth was amphigenous, mainly on the upper leaf surface, covering the whole leaf and with irregular patches on inflorescences and stems. Hyphae were ectophytic with lobed appressoria. Conidiophores presented foot cells 22.5 to 35 (30) × 5.75 to 7 (6.3) µm followed by two cells, one shorter and one longer than the foot cell. Conidia were produced singly, most subcylindric to cylindric, lacked fibrosin bodies, and measured 31.2 to 42 (36.2) × 8.7 to 11.2 (10.5) µm. The teleomorph was not observed. Genomic DNA was extracted from infected leaves; sequences of the internal transcribed spacers (ITS) inclusive of 5.8S rDNA were amplified using previously described primers specific for Erysiphales (3). The ITS sequences shared 100% homology to Erysiphe heraclei specimen VPRI41227 from carrot in Australia (GenBank Accession No. EU371725). On the basis of the morphological characteristics observed and the ITS rDNA sequences, the pathogen was identified as E. heraclei DC. The ITS sequence was deposited in NCBI as Accession No. GU252368. Pathogenicity tests were conducted twice on a total of 10 healthy 8-week-old carrot plants cv. Nantesa. Infected plants were placed in close proximity to healthy plants and maintained in a greenhouse at 27 ± 5°C. Initial signs and symptoms were observed 3 weeks after inoculation and appeared as small, white colonies, which later coalesced and covered most of the foliage. Microscopic examination of the conidia and mycelial morphology matched the originally described pathogen, E. heraclei. Powdery mildew caused by this pathogen has been extensively reported on diverse species and genera of the Apiaceae in Europe and remains one of the most important diseases of carrot (2). The appearance of E. heraclei in diverse regions on a variety of umbelliferous crops indicates that formae speciales have spread, infecting different and specific hosts (1-3). Recently, E. heraclei has been reported on parsley in Puebla, Mexico (4). To our knowledge, this is the first report of E. heraclei causing powdery mildew on carrot in Michoacan, Mexico. This pathogen should be considered as a threat to commercial carrot crops in Mexico. Other crops in the Apiaceae may not be at risk in this area if this powdery mildew is specific for carrots. References: (1) B. J. Aegerter. Page 22 in: Compendium of Umbelliferous Crop Diseases. The American Phytopathological Society, St. Paul, MN, 2002. (2) U. Braun. The Powdery Mildew (Erysiphales) of Europe. Gustav Fischer-Verlag. Jena, Germany, 1995. (3) J. H. Cunnington et al. Australas. Plant Pathol. 32:421, 2003. (4) M. J. Yáñez-Morales et al. Schlechtendalia 19:47, 2009.

Site-bond percolation solution to preventing the propagation of Phytophthora zoospores on plantations.

We propose a strategy based on the site-bond percolation to minimize the propagation of Phytophthora zoospores on plantations, consisting in introducing physical barriers between neighboring plants. Two clustering processes are distinguished: (i) one of cells with the presence of the pathogen, detected on soil analysis, and (ii) that of diseased plants, revealed from a visual inspection of the plantation. The former is well described by the standard site-bond percolation. In the latter, the percolation threshold is fitted by a Tsallis distribution when no barriers are introduced. We provide, for both cases, the formulas for the minimal barrier density to prevent the emergence of the spanning cluster. Though this work is focused on a specific pathogen, the model presented here can also be applied to prevent the spreading of other pathogens that disseminate, by other means, from one plant to the neighboring ones. Finally, the application of this strategy to three types of commercially important Mexican chili plants is also shown.

Root Rot of Hydroponically Grown Lettuce Caused by Phytophthora drechsleri in Mexico.

During March of 2008, bibb lettuce (Lactuca sativa L.) plants with severe wilting and root rot were observed in a commercial liquid-hydroponic greenhouse in Guanajuato, Mexico. By July of that year, the disease affected most plants in the facility. A Phytophthora sp. was consistently isolated from diseased roots on potato carrot agar. Several Phytophthora isolates were morphologically characterized. Sporulation was achieved by placing colonized disks of clarified V8 juice agar (V8A) into nonautoclaved soil extract (10 g avocado soil/1,000 ml distilled water, stirred for 3 h, and filtered). Sporangia were persistent, nonpapillate, and 40 to 58 µm long × 30 to 40 µm wide. External and internal proliferation was observed. Hyphal swellings were predominantly rounded. Oospores were not observed. The isolates grew on V8A at 35°C. Pathogenicity tests were conducted twice by utilizing a representative isolate (AC1) on bibb lettuce seedlings (10 replicates per experiment). Seeds were placed on sterile, water-soaked paper in petri dishes. After 10 days, each lettuce seedling was placed into a tube containing approximately 2 ml of sterile distilled water and 2,000 zoospores. Control plants were placed in tubes with water only. Plants were incubated for 7 days in a moist chamber at 25°C. Symptoms of wilting and root necrosis were observed 2 to 3 days after inoculation. All plants were dead 5 to 7 days after inoculation. A Phytophthora sp. was always isolated from the roots of inoculated plants. Control plants remained healthy. The pathogen was identified as Phytophthora drechsleri Tucker according to morphological characteristics. To confirm the identity of the pathogen, sequences of the internal transcribed spacers (ITS) were obtained from three representative isolates. The ITS sequences that were obtained shared 100% homology to several strains of P. dreschleri, including isolates from cucurbits (GenBank Accession No. AF228097). The ITS sequence was deposited in NCBI as Accession No. FJ790770. P. cryptogea and P. dreschleri have been reported as causing root rot on lettuce grown hydroponically in the United States and Korea (1,2). To our knowledge, this is the first report of P. drechsleri causing root rot on lettuce in Mexico. References: (1) H. J. Jee et al. Plant Pathol. J. 17:311, 2001. (2) A. R. Linde et al. Plant Dis. 74:1037, 1990.

First Report of Powdery Mildew on Greenhouse Tomatoes Caused by Oidium neolycopersici in Michoacan, Mexico.

During June and July of 2007, powdery mildew-infected tomato (Lycopersicum esculentum Mill. cv. Reserve) plants were observed in a commercial greenhouse with an open hydroponic system in Morelia County. Disease incidence increased from 0.5% to more than 90% in 1 month. Infected plants showed leaves with irregular areas of dense, white mycelium covering most of the upper surface. Microscopic analysis showed hyaline, septate hyphae with lobed appressoria. Conidia were ellipsoid to ovoid and 30 to 45 (38) µm × 15 to 20 (16) µm. Conidiophores were erect, 80 to 120 (103) µm, consisted of a foot cell 42 to 67 (56) µm, and two to three short cells. Conidia were produced singly. On the basis of the observed morphological characteristics, the fungus was identified as Oidium neolycopersici L. Kiss (1). Pathogenicity tests were conducted on fourth true-leaf tomato seedlings cv. Reserve under greenhouse conditions (22 ± 5°C). Inoculation was performed by transferring conidia from infected leaves to the leaves of uninfected tomato seedlings with a single-edged razor blade. Powdery mildew symptoms began to develop 7 days after inoculation. Symptoms and morphological characteristics were similar to those observed in the commercial greenhouse. Noninoculated plants remained healthy throughout the experiments. To our knowledge, this is the first report of O. neolycopersici causing powdery mildew on tomato in Michoacan, Mexico. This disease has been reported from Canada, Europe, Japan, the United States (2), and Venezuela (3) on greenhouse and field tomato crops. The observed high incidence and severe infection indicates that this disease may become an important problem in greenhouse tomatoes in Mexico. References: (1) L. Kiss et al. Mycol. Res. 105:684, 2001. (2) L. Kiss et al. Plant Dis. 89:491, 2005. (3) J. O. Montilla et al. Plant Dis. 91:910, 2007.

[Video-polysomnography in preterm infants with birth weight under 1,800 g]. / Estudio vídeo-polisomnográfico en prematuros menores de 1.800g.

INTRODUCTION: Neonatal video-polysomnography (VPSG) in preterm infants is indicated to rule out sleep-related respiratory disturbances before discharge from neonatal units and to study neonatal sleep patterns and associated pathologic conditions. OBJECTIVE: To study the presence of apnea, hypopnea, and periodic breathing in preterm infants with low birth weight (< 1,800 g) and to describe their cardio-respiratory variability, electroencephalogram (EEG) abnormalities, and brain maturity in connection with sleep stages. METHOD: We performed a cross-sectional, descriptive study through review of the clinical histories of preterm infants with a birth weight < 1,800 g who had undergone VPSG (2001-2003). The most common indication for VPSG was the presence of sleep apneas and oxygen desaturation. The data obtained were used for descriptive statistical analysis. RESULTS: Thirty-one infants were studied, with a mean gestational age of 27.8 weeks and a mean birth weight of 1,158 g. The most frequently associated condition was hyalin membrane disease (68 %). Cardiorespiratory impairment was detected in 65 %, altered sleep pattern in 6 %, immature EEG recording in 32 %, abnormal pattern in 13 %, and immature plus abnormal pattern in 3 %. Sixty-nine percent of the infants required home monitoring and 23 % needed oxygen at home. Four infants were readmitted on several occasions due to apnea. CONCLUSION: We wish to stress the importance of carrying out VPSG with suitable methodology in preterm infants with cardiorespiratory or neurological impairment in order to detect abnormalities on EEG and to assess brain maturity and sleep-related abnormal respiratory events.

[Necrotizing fasciitis due to Streptococcus pyogenes]. / Fascitis necrosante por Streptococcus pyogenes.

Necrotizing fasciitis is a severe infection, with systemic involvement and tissue necrosis. The clinical course is rapid and often fatal. Although this entity is uncommon, early recognition and treatment is essential to improve prognosis. Necrotizing fasciitis should be suspected when there are symptoms of toxicity and there is severe pain, frequently out of proportion to the clinical findings. In addition, in the last few years the incidence of invasive disease due to Streptococcus pyogenes in children has increased. Treatment is based on life support, aggressive debridement, and antimicrobial therapy. Intravenous immunoglobulin (IVIG) as adjunctive therapy seems useful and reduces mortality. The case of an infant with necrotizing fasciitis of four extremities is presented.

[Paramedian bithalamic infarct syndrome: report of five new cases]. / Síndrome del infarto bitalámico paramediano. Presentación de 5 casos.

Five patients were examined suffering from bilateral paramedian thalamic infarction, caused by occlusion of the posterior paramedian thalamo-subthalamic arteries, when they begin from one single pedicle. All cases began with obnubilation or transitory coma, followed by hypersomnia. Four patients showed vertical gaze paralysis, and the fifth vertical nystagmus. In three cases, nuclear lesion of the III cranial nerve was observed along with alteration of the photomotor reflexes, and there was miosis in one case. All were suffering from weakness in one or another limb or facial paresis and generalised acute hypotonia: only one patient had hemihypostesia. All five had dysarthria, ataxy and dysmetria, one had asterixis and two spasmodic crying. Between 5 and 12 months later, one had akinetic mutism and vertical gaze paralysis as the most noteworthy signs. The neuroradiological images show a bilateral ischemic lesion in the paramedian thalamic region, which extends in some cases to the anterior nucleus and in one case to the pulvinars; the lesion continues through the subthalamic regions and the medial part of the mesencephalic tegmentum, with a clear extension to the medial region of the cerebral peduncles in three cases and to the tectum in one case.

[Primary tracheobronchial amyloidosis. Report of a case]. / Amiloidosis traqueobronquial primaria. Reporte de un caso.

We present a patient with primary tracheobronquial amiloidosis diffuse, presenting with asthma-like dysnea. The diagnosis was made through the broncoscopy and biopsy of infiltrated bronchial mucosa.

[Emergence of invasive pneumococcal disease caused by non-vaccine serotypes in the era of the 7-valent conjugate vaccine]. / Serotipos no vacunales emergentes causantes de enfermedad neumocócica invasora en la era de la vacuna 7-valente.

INTRODUCTION: There has been an increased incidence in invasive pneumococcal disease (IPD) produced by non-vaccine serotype (NVS) of Streptococcus pneumoniae after the introduction of PCV7. Our objective was to describe the epidemiological, clinical and microbiological characteristics of IPD caused by NVS in a tertiary hospital in Madrid. PATIENTS AND METHODS: Retrospective (1998-2004) and prospective (2005-2009) study evaluating IPD caused by NVS in children. The study was divided into three periods: P1 (1998-2001) when PCV7 was not commercialized; P2 (2002-2005) with 40% vaccine coverage among children; and P3 (2006-2009) when the vaccine was added to the Childhood Immunization Schedule in Madrid. RESULTS: We analyzed 155 cases of IPD. One hundred and fifty of these isolates were serotyped (100 were NVS). There was an increase in the prevalence of IPD from P1 (31%) to P2 (54%) and P3 (91%). The most relevant emerging serotypes were 19A, 7F, 1, 5, 3 and 15C. The most significant clinical syndromes produced by some specific serotypes were as follows: lower respiratory tract infection (LRTI) by serotypes 1, 3, 5 and 15C; LRTI, primary bacteremia and meningitis by serotype 19A; and primary bacteremia by serotype 7F (66%). The large majority (83.8%) of NVS were sensitive to penicillin. CONCLUSIONS: There has been an increased prevalence of IPD caused by NVS since the introduction of PCV7. These changes should prompt the introduction of new pneumococcal vaccines, which include most of the NVS, in the childhood immunization calendar to prevent IPD in children.

[Clinical impact of introducing ventilation with high flow oxygen in the treatment of bronchiolitis in a paediatric ward]. / Impacto clínico de la implantación de la ventilación por alto flujo de oxígeno en el tratamiento de la bronquiolitis en una planta de hospitalización pediátrica.

OBJECTIVE: To analyse the safety and efficacy of high-flow oxygen therapy for treatment of moderate to severe bronchiolitis in children admitted to the paediatric hospital wards. METHODS: A prospective observational study was conducted on children < 18 months of age with bronchiolitis admitted to the paediatric ward of a tertiary-care teaching hospital during the 2011-12 respiratory season. Children were treated with a high-flow ventilation system (Fisher & Paykel). Clinical and cardio-respiratory parameters were evaluated every hour for the duration of therapy. RESULTS: A total of 25 patients, with a median age of 2 months (range: 0.6-11 months) were included. Respiratory syncytial virus (RSV) was positive in 75% of cases. Indications for high-flow therapy included: progressive respiratory distress (Wood-Downes ≥ 8) (88%), apnoea (8%) and desaturation (4%). Median duration of therapy was 4 days (range: 3-7 days), with a median of 9 days in hospital (range: 8-12 days). High flow therapy was associated with a significant decrease in cardio-respiratory parameters, heart rate, respiratory rate, which resulted in a significant improvement of the Wood-Downes Score (from 10±1.21 to 3±0.77, P=.001). No adverse effects were observed. Five patients (20%) were admitted to the Paediatric Intensive Care Unit (PICU), which represents an 80% reduction of PICU admissions compared with historic data of previous years. CONCLUSIONS: High-flow ventilation therapy achieved a significant improvement in heart rate, respiratory rate, and scale of severity in patients with bronchiolitis. This novel therapeutic strategy allows safe management of bronchiolitis patients in the regular ward, reducing admissions to the PICU.

[Increase in the incidence of invasive pneumococcal disease caused by serotype 19A prior to the implementation of the expanded pneumococcal vaccines]. / Aumento de la incidencia de enfermedad neumocócica invasora producida por el serotipo 19A previo a la introducción de las vacunas neumocócicas ampliadas.

OBJECTIVE: To describe the epidemiology, clinical syndromes and microbiological characteristics of serotype 19A as the main cause of invasive pneumococcal disease (IPD) in children admitted to a tertiary hospital in Spain. METHODS: A retrospective (1998-2004) and prospective (2005-2009) study was conducted on children with IPD produced by serotype 19A. The study was divided into three periods (P): P1 (1998-2001) when PCV7 had not been commercialized; P2 (2002-2005) with 40% vaccine coverage among children; and P3 (2006-2009) when the vaccine was added to the Childhood Immunization Schedule in Madrid. RESULTS: A total of 155 isolates of Streptococcus pneumoniae (SP) producing IPD were analysed, with 21 of them being serotype 19A (14%). An increased prevalence of serotype 19A was found: 2/45 cases (4.4%) in P1, 3/41 cases (7.3%) in P2 and 16/69 cases (23.2%) in P3. It occurred mostly in children younger than 2 years (16/21; 76%). This serotype was the main cause of meningitis (5/20; 25%), pleural empyema (3/22; 14%) and bacteraemic mastoiditis (2/4; 50%). Thirteen isolates (61.5%) had an MIC ≥ 0.12µ/ml for penicillin in extra-meningeal infections, and 3 of the 5 isolates causing meningitis (60%) had an MIC ≥ 1µ/ml for cefotaxime. CONCLUSIONS: Serotype 19A was the main causal agent of IPD in the PCV7 era (P3), with high antibiotic resistance rates. This serotype was responsible for all types of IPD, being the main cause of meningitis.

[Accidental contact with syringes used by intravenous drug users (IDU): a decade of study]. / Contactos accidentales con jeringas utilizadas en drogadicción (ADVP): una década de seguimiento.

OBJECTIVE: The increase in drug addiction, AIDS, hepatitis C and B transmission is a problem the society faces with growing frequency, mainly due to syringes and other material used by seropositive patients being left in public place, with children being one of the groups being at greatest risk. We present our experience in accidents with syringes used by intravenous drug users (IDU) in patients less than 16 years of age during the last 11 years. PATIENTS AND METHODS: All patients attending our emergency department with diagnosis of contact with syringes used by IDU were prospectively studied. All patients were treated according to the follow-up protocol of accidental contact with syringes used by IDU. RESULTS: We studied 183 patients between 0 and 16 years of age, with a male gender predominance, the average age at presentation was 6.7 years. The majority of cases occurred during the months of April through August. One hundred twenty-eight cases completed the control after 1 year. At the one year control after the accident, 99% of the patients were anti-HBs antibody positive. Other markers positive for HBV were found in 15% of the cases. Markers for HCV were found in only 9 of 84 patients studied. Only one patient that did not receive either the gamma globulin nor the vaccine developed hepatitis B infection. No patient showed HIV conversion during the time of the study. CONCLUSIONS: The risk of HIV and HCV after accidental puncture with syringes used by IDU is nearly none. Hepatitis B virus infection is the major risk. HBV transmission in the workplace can be largely eliminated due to the increased use of hepatitis B vaccine.

[Coinfection with chlamydia and mycoplasma. Incidence in our environment]. / Coinfección por Chlamydia y Mycoplasma. Incidencia en nuestro medio.

OBJECTIVES: To investigate the presence Mycoplasma pneumoniae and Chlamydia pneumoniae and to determine their importance as the cause of community-acquired pneumonia in childhood. MATERIAL AND METHODS: We performed a retrospective descriptive study of all the patients aged less than 15 years old diagnosed with community-acquired pneumonia due to M. pneumoniae in the pediatric emergency department of our hospital between May 1998 and May 2000. Patients in whom C. pneumoniae was also identified as a cause of pneumonia were investigated. RESULTS: Of 242 cases of community-acquired pneumonia, 82 were due to M. pneumoniae (34.7 %) and 32 were due to C. pneumoniae (13.22 %) Of these, eight cases were coinfections with C. pneumoniae and M. pneumoniae. Most infections occurred in boys (5/8). The mean age at diagnosis was 7.7 years. No seasonal predominance was found. CONCLUSIONS: Both C. pneumoniae and M. pneumoniae play a substantial role in community-acquired pneumonia in children aged more than 5 years old. Although coinfection with both species usually worsens the course of the disease, outcome in all the patients studied was satisfactory.