[Malaria in the South of Madrid: a clinical and epidemiological review]. / Revisión de los casos de paludismo de los últimos 12 años en el Hospital Universitario de Getafe.

INTRODUCTION: Malaria has increased in Spain, and is potentially severe in children. Information on pediatric malaria in Spain is scarce. The aim is to evaluate the clinical, therapeutic and epidemiological characteristics of children diagnosed with malaria in our hospital. PATIENTS AND METHODS: A retrospective descriptive study was performed on all pediatric cases of malaria diagnosed in Getafe University Hospital, from January 1995 to November 2006. Epidemiological and clinical features, as well as diagnostic methods, treatments and outcome were studied. An analysis of two comparative periods (before and after January 2000) was carried out. RESULTS: Eighteen cases of confirmed malaria were identified, twelve girls and six boys. The age range was from 13 months to 13 years with a median age of 60 months. All patients had recently travelled to or from endemic countries. Despite having a stable number of admissions to hospital over time, all but two patients were diagnosed in the second period (P<0.01). Fever and gastrointestinal symptoms were the most common symptoms, with liver or spleen enlargement in 75%. Thrombocytopenia and anemia were common. No cases of complicated malaria or death occurred. Plasmodium identification by microscopic examination was used in all cases. Identification of Plasmodium species with PCR was carried out in 16 children. P. falciparum was found in 89% of these cases. Quinine-sulphate and clindamycin were used in 72%. CONCLUSIONS: The incidence of pediatric malaria is increasing in the southern area of Madrid, with P. falciparum as the most frequently identified species. Microscopic visualization or identification of its antigen are gold-standard diagnostic methods, however, identification with PCR is essential upon admission to determine the species and discard possible multiple infestations. Pediatricians must learn to suspect this potentially severe disease, in order to establish an early treatment that may improve the prognosis.

Delirium in hospitalised older persons: review.

Delirium, a mental disorder that becomes established over a few hours or days, is characterised by fluctuating attention and cognitive states. This article reviews the disorder, which has all the features of an important geriatric syndrome: it appears mainly in persons older than 65 years of age, is closely linked with very prevalent diseases and complications arising in the elderly, and is the mode of presentation of many other diseases in this age group. We discuss diagnostic, clinical preventive and therapeutic aspects and analyse the most common risk and precipitating factors in our hospitalised patients from the viewpoint of clinical practice. Finally, we propose a scheme for the prevention and treatment of delirium.

[Modification of the immune response in the elderly with nutritional treatments]. / Modificación de la respuesta inmune en los ancianos con tratamientos nutricionales.

The aging associates to it unites alteration of the immune response, this is well documented. This alteration can contribute to much of the illnesses associated to the age like repetition infections, cancer and illnesses autoinmunes. Is in the immunity mediated by cells where the main dysfunction resides, although with accuracy it is not clarified which is the intimate cause that produces it, although certainly the smallest presence in a co-estimulative of the recognition and the immune response as the receiver CD28, seem to play a key paper between to the descent of the thymic activity. The relationship between immunity and nutrition is known, as well as the high nutritional deficit prevalence in the elderly. In this work we pass reviews to that published in relation to the possibilities of improving the immune response in the elderly with nutritional treatments.