Short communication: Effect of refrigerated storage on the pH and bacterial content of pasteurized human donor milk.

Once pasteurized donor milk is thawed for its administration to a preterm or sick neonate, and until it is administered, it is kept refrigerated at 4 to 6°C for 24 h. After this time, unconsumed milk is discarded. This time has not been extended, primarily because of the concern of bacterial contamination. The aim of this study was to determine the changes in pH and bacterial count when pasteurized donor milk was kept under refrigeration for a prolonged period (14 d). In this prospective study, 30 samples of pasteurized donor milk from 18 donors were analyzed. Milk was handled following the regular operating protocols established in the neonatal unit and was kept refrigerated after thawing. pH measurements and bacteriology (on blood agar and MacConkey agar plates) were performed on each sample at time 0 (immediately after thawing) and then every day for 14 d. Changes in pH of samples over time were evaluated with linear mixed-effects regression models. A slow but gradual increase in milk pH was observed starting from the first day [mean (±SD) pH of 7.30 (±0.18) at time 0 and 7.69 (±0.2) on d 14]. No bacterial growth was observed in any of the samples throughout the complete trial except in one sample, in which Bacillus flexus was isolated. In conclusion, pasteurized human donor milk maintains its microbiological quality when properly handled and refrigerated (4-6°C). The slight and continuous increase in milk pH after the first day could be due to changes in the solubility of calcium and phosphate during refrigerated storage.

Prematurity: A medical history of obligatory consideration when assessing the retinal ganglion cell complex.

INTRODUCTION: Premature children birth and survival is becoming more frequent due to the improvement in obstetric and neonatal care. This makes it increasingly common to find patients with history of preterm birth in ophthalmology clinics, both in pediatric and adult ages. Premature birth can lead to ocular structural changes, being possible to affect the ganglion cell complex (GCC), among other structures, which can be studied using optical coherence tomography. MATERIALS AND METHODS: To carry out a bibliographic review of the studies that analyze GCC in patients with a history of prematurity compared with patients born at term. RESULTS: Several studies that analyze GCC in patients with a history of prematurity are referenced and their results are studied. CONCLUSIONS: In our clinical practice, knowing the history of prematurity is fundamental in the assessment of GCC measured by optical coherence tomography, since this layer is different in the patients with a history of prematurity compared to patients born at term.

[Pyomyositis in children: not only a tropical disease]. / Piomiositis en los niños: no sólo una enfermedad tropical.

INTRODUCTION: Pyomyositis is an acute bacterial infection of skeletal striated muscle typical of tropical countries but infrequent in our environment. The present review aims to describe the clinical characteristics, epidemiology, etiology, diagnosis and outcome of patients with pyomyositis in our hospital. MATERIAL AND METHODS: The medical records of patients diagnosed with pyomyositis in our hospital from 2002 to 2005 were reviewed. Epidemiological, clinical, and microbiological data as well as the diagnostic tests and treatment strategies used were gathered and a descriptive analysis was performed. RESULTS: There were seven patients (five boys and two girls). The mean age of the patients was 8.6 years. Five patients (70%) presented during the 6 warmer months. There were four secondary cases (one HIV infection, three musculoskeletal injuries). The most frequent sites were the psoas-iliac region and thigh. The main symptoms at presentation were pain and fever. The most common diagnostic imaging modality was ultrasound examination, although magnetic resonance imaging had the highest diagnostic yield (sensitivity of 100% versus 33% for ultrasound). The most prevalent microorganism in our series was Staphylococcus aureus (found in three out of seven patients). Only two abscesses were surgically drained and the remainder were treated with antibiotics alone, first intravenously (mean of 17 days) and then orally (mean of 26 days). None of our patients developed sequelae. CONCLUSIONS: Pyomyositis should be included in the differential diagnosis in children with fever, pain and/or functional impotence, even though this entity is infrequent in our environment. The most sensitive diagnostic test is magnetic resonance imaging. With early diagnosis and correct treatment, outcome is good.

[Residents in pediatrics in primary care centers: 5 years of compulsory rotation in Health Area 11 of Madrid]. / Residentes de Pediatría en Atención Primaria: 5 años de rotación obligatoria en el Area 11 de Madrid.

INTRODUCTION: Currently, primary care center rotation is not compulsory for residents in pediatrics. The aim of this study was to describe the experience of tutors and residents during primary care rotation, which has been compulsory for residents in the Hospital 12 Octubre in Madrid for the last 5 years. METHODS: We performed an observational, descriptive, cross-sectional study through a survey carried out in June 2005 of 12 accredited tutors and 38 residents. RESULTS: Sixty-eight percent of the residents did not know how primary care centers worked. Eighty-four percent of the residents considered that the first year of residence was the best year for rotation in primary care, 64% would choose the center according to the tutor, and 97% highlighted the teaching of the tutors. Tutors and residents believed that the length of the rotation (1.5 months) was short. All tutors and residents thought that the main objectives were achieved and recognized the importance of the rotation. Tutors found teaching gratifying and all agreed that their work should be compensated by professional recognition or greater access to training. Coordination with the hospital's pediatric teaching board should be improved. CONCLUSIONS: Compulsory rotation in primary care is feasible and is a positive component of pediatrics training. Residents and tutors considered this experience to be satisfactory and well adapted to the established objectives. The position of teaching coordinator should be created in primary care, the length of rotations prolonged and tutors' work should be compensated.

[Effect of freezing on the "creamatocrit" measurement of the lipid content of human donor milk]. / Medida por crematocrito del contenido calórico de la leche materna donada congelada.

OBJECTIVE: To determine, by the creamatocrit measurement, the effect on the fat content of raw and pasteurized donor milk of freezing during 3 months at -20 °C. METHODS: The evolution of the creamatocrit measurement (following Lucas technique) on frozen (-20 °C), raw and pasteurized human milk, was analyzed during 3 months. RESULTS: The fat content of raw milk (n=44) was 3.19 g/dl at the beginning and 2.86 g/dl after 3 months frozen (p=0.02). In pasteurized milk (n=36) fat content at the first determination was 2.59 g/dl and 2.20 g/dl after 1 month frozen (p=0.01). Afterwards there were no significant changes up to 3 months frozen. Variability was observed in the intermediate values. CONCLUSIONS: A reduction on the fat content measurement of raw and pasteurized donor human milk after freezing was observed. Freezing does not inactivate the milk lipase but does destroy the fat globule. Creamatocrit measurement may not be the best method to determine the fat content of processed human milk.

[Clinical impact of opening a human milk bank in a neonatal unit]. / Impacto en la práctica clínica de la apertura de un banco de leche en una unidad neonatal.

INTRODUCTION: The benefits of donor human milk compared with artificial formulas have been well demonstrated; nevertheless the impact in the clinical practice of opening a human milk bank within a neonatal unit has not yet been studied. The main aim of this study was to analyze the impact on the clinical practice of opening a human milk bank in a neonatal unit to provide donor human milk for preterm infants ≤ 32 weeks of gestational age. METHODS: A before and after study was designed, with the intervention being the opening a human milk bank. Preterm infants ≤ 32 weeks of gestational age born in the Hospital 12 Octubre from July to December 2005 and January to June 2008 (firsts 6 months after opening the human milk bank) were included. RESULTS: After opening the human milk bank, enteral feedings were started 31h before (P<.001), 100ml/kg/day were achieved 59.5h before (P<.001) and 150 ml/kg/day 52 h before (P=.002). Enteral feedings were never started LM with artificial formula, the exposure to formula in the first 15 days of life was reduced from 50% to 16.6%, and it's consumption during the first 28 days of life was significantly reduced. There was a higher consumption of own mother's milk during the hospital stay, and a higher rate of exclusive breastfeeding at hospital discharge (54% vs 40%). CONCLUSIONS: The availability of donor human milk has led to quicker progression with enteral feedings and earlier withdrawal of parenteral nutrition. It has reduced the exposure to artificial formulas, and has also increased the intake of own mother's milk during the hospital stay and the rate of exclusive breastfeeding at hospital discharge.

[Profile of human milk bank donors and relationship with the length of the donation]. / Características de las mujeres donantes de un banco de leche materna y relación con el tiempo de donación.

INTRODUCTION: The promotion of Human Milk Banks is an important social service. The Human Milk Banks depend on donors, and knowing the profile of donors seems quite important. OBJECTIVE: To study the demographics and lifestyles of the donors, the reasons or influences for donating, and to associate these variables with the length of the donation. METHODS: This is a descriptive, cross-sectional study conducted on 168 mothers who answered the written questionnaire when they agreed to become donors. 98 (58%) responded to the telephone interview. RESULTS: The mean age was 33.1 ± 4.5 years. Of the total 27.9% lived outside Madrid and 21.4% were immigrants, with 23.7% working full time, 65.3% had a university education, and 96.2% had a stable partner. The main reasons for donating were too much milk (77%), and to help others (75%). The main obstacle was transportation to the Human Milk Bank for 20% of the donors, and for 61% the main reason for terminating donation was due to reaching the end of lactation. A longer donation is associated with: having a term newborn, with birth weight over 1500 g, starting donating early and reconciling the donation to the work situation. CONCLUSION: The most common donor profile was a young woman, with university education and a stable partner. Having a term new born, starting donating early, and the conciliation with work is associated with longer donations. Milk pick-up at home would make donation easier.

La prematuridad: un antecedente de obligada consideración a la hora de valorar el complejo de células ganglionares de la retina / Prematurity: a medical history of obligatory consideration when assessing the retinal ganglion cell complex

Introducción: La supervivencia de los niños prematuros es cada vez más frecuente siendo cada vez más habitual encontrar pacientes con este antecedente en las consultas de oftalmología. El parto prematuro puede conllevar cambios estructurales a nivel ocular, pudiéndose afectar entre otras estructuras el complejo de células ganglionares (CCG), que puede ser estudiado mediante la tomografía de coherencia óptica.Materiales y métodosRealizar una revisión bibliográfica de los estudios que analizan el CCG en pacientes con antecedente de prematuridad y lo comparan con pacientes nacidos a término.ResultadosSe referencian varios estudios que analizan el CCG en población con antecedente de prematuridad y se estudian los distintos resultados obtenidos.ConclusionesEn nuestra práctica clínica, conocer el antecedente de prematuridad es fundamental en la valoración del CCG medido por tomografía de coherencia óptica ya que el grosor de esta capa es distinta en la población con antecedente de prematuridad comparada con la población a término. (AU)

Introduction: Premature children birth and survival is becoming more frequent due to the improvement in obstetric and neonatal care. This makes it increasingly common to find patients with history of preterm birth in ophthalmology clinics, both in pediatric and adult ages. Premature birth can lead to ocular structural changes, being possible to affect the ganglion cell complex (GCC), among other structures, which can be studied using optical coherence tomography.Materials and methodsTo carry out a bibliographic review of the studies that analyze GCC in patients with a history of prematurity compared with patients born at term.ResultsSeveral studies that analyze GCC in patients with a history of prematurity are referenced and their results are studied.ConclusionsIn our clinical practice, knowing the history of prematurity is fundamental in the assessment of GCC measured by optical coherence tomography, since this layer is different in the patients with a history of prematurity compared to patients born at term. (AU)

Medida por crematocrito del contenido calórico de la leche materna donada congelada / Effect of freezing on the "creamatocrit" measurement of the lipid content of human donor milk

OBJETIVO: Determinar, mediante crematocrito, las modificaciones del contenido graso de la leche materna cruda y pasteurizada a lo largo de 3 meses de congelación. MÉTODO: Se analizó la evolución del crematocrito (fórmula de Lucas) en leche cruda y pasteurizada a lo largo de 3 meses de congelación a −20°C. RESULTADOS: La grasa en leche cruda (n=44) fue 3,19g/dl al inicio y 2,86g/dl a los 3meses de congelación (p = 0,02). En leche pasteurizada (n=36), al inicio fue 2,59g/dl y 2,20g/dl al mes de congelación (p = 0,01), posteriormente, hasta los 3 meses, no hubo cambios significativos. Se observó variabilidad en los valores intermedios. CONCLUSIONES: Se observó una disminución en la medida de la grasa tras congelación en leche cruda y pasteurizada. La congelación no impide la acción de la lipasa y también afecta al glóbulo de grasa. Probablemente, el crematocrito no sea el método óptimo para cuantificar la grasa en leche ya procesada

OBJECTIVE: To determine, by the creamatocrit measurement, the effect on the fat content of raw and pasteurized donor milk of freezing during 3 months at −20 °C. METHODS: The evolution of the creamatocrit measurement (following Lucas technique) on frozen (−20 °C), raw and pasteurized human milk, was analyzed during 3 months. RESULTS: The fat content of raw milk (n=44) was 3.19 g/dl at the beginning and 2.86 g/dl after 3 months frozen (p = 0.02). In pasteurized milk (n=36) fat content at the first determination was 2.59 g/dl and 2.20 g/dl after 1 month frozen (p = 0.01). Afterwards there were no significant changes up to 3 months frozen. Variability was observed in the intermediate values. CONCLUSIONS: A reduction on the fat content measurement of raw and pasteurized donor human milk after freezing was observed. Freezing does not inactivate the milk lipase but does destroy the fat globule. Creamatocrit measurement may not be the best method to determine the fat content of processed human milk

Impacto en la práctica clínica de la apertura de un banco de leche en una unidad neonatal / Clinical impact of opening a human milk bank in a neonatal unit

INTRODUCCIÓN: Los beneficios de la leche donada frente a la fórmula artificial están demostrados, sin embargo no se conoce la influencia de la apertura de un banco de leche en la práctica clínica habitual. El objetivo de este estudio fue medir el impacto en la práctica clínica de la disponibilidad de leche donada para la nutrición de los prematuros ≤32 semanas de edad gestacional. MÉTODOS: Estudio antes-después de la apertura de un banco de leche. Se incluyeron los ≤32 semanas nacidos en el Hospital 12 de Octubre de julio-diciembre de 2005 y de enero-junio de 2008 (6 primeros meses tras la apertura del banco de leche). RESULTADOS: La apertura del banco de leche permitió empezar 31h antes (p < 0,001) la alimentación enteral, se alcanzaron 59,5h antes los 100ml/kg/día (p < 0,001) y 52h antes los 150ml/kg/día (p = 0,002), permitiendo retirar 72h antes la nutrición parenteral. En ningún prematuro se inició la alimentación enteral con fórmula artificial, la exposición a la misma en los primeros 15días de vida bajó del 50 al 16,6% y su consumo durante los primeros 28 días fue significativamente menor. La cantidad consumida de leche de la propia madre fue mayor, al igual que la tasa de lactancia materna exclusiva al alta (54 vs. 40%). CONCLUSIONES: Disponer de leche donada ha permitido avanzar más rápidamente con la nutrición enteral y retirar antes la nutrición parenteral. La exposición a fórmula artificial ha sido menor y mayor el consumo de leche de madre propia y la lactancia materna al alta

INTRODUCTION: The benefits of donor human milk compared with artificial formulas have been well demonstrated; nevertheless the impact in the clinical practice of opening a human milk bank within a neonatal unit has not yet been studied. The main aim of this study was to analyze the impact on the clinical practice of opening a human milk bank in a neonatal unit to provide donor human milk for preterm infants ≤32 weeks of gestational age. METHODS: A before and after study was designed, with the intervention being the opening a human milk bank. Preterm infants ≤32 weeks of gestational age born in the Hospital 12 Octubre from July to December 2005 and January to June 2008 (firsts 6 months after opening the human milk bank) were included. RESULTS: After opening the human milk bank, enteral feedings were started 31h before (P<0.001), 100ml/kg/day were achieved 59.5h before (P<0.001) and 150ml/kg/day 52h before (P=0.002). Enteral feedings were never started LM with artificial formula, the exposure to formula in the first 15 days of life was reduced from 50% to 16.6%, and it's consumption during the first 28 days of life was significantly reduced. There was a higher consumption of own mother's milk during the hospital stay, and a higher rate of exclusive breastfeeding at hospital discharge (54% vs 40%). CONCLUSIONS: The availability of donor human milk has led to quicker progression with enteral feedings and earlier withdrawal of parenteral nutrition. It has reduced the exposure to artificial formulas, and has also increased the intake of own mother's milk during the hospital stay and the rate of exclusive breastfeeding at hospital discharge

Características de las mujeres donantes de un banco de leche materna y relación con el tiempo de donación / Profile of human milk bank donors and relationship with the length of the donation

INTRODUCCIÓN: Promocionar los bancos de leche materna es una importante labor social y sanitaria. Los bancos dependen de las donaciones de madres lactantes, por ello la importancia de conocer las características de las donantes. OBJETIVOS: Describir las características demográficas de las donantes, proporcionar información sobre los factores que les influyen o motivan y relacionar sus características con el tiempo de donación. MÉTODOS: Estudio descriptivo prospectivo; 168 donantes cumplimentaron un cuestionaron escrito cuando iniciaron la donación. A 98 (58%) de ellas se les pasó una entrevista telefónica. RESULTADOS: La edad media fue 33,1 ± 4,5 años. El 27,9% vivía fuera de Madrid y un 21,4% eran inmigrantes. El 23,7% tenía un empleo a jornada completa, el 65,3% formación universitaria y el 96,2% pareja estable. La principal razón para donar fue exceso de leche (77%) y querer ayudar a otras mujeres (75%). El 20% identificó el transporte de la leche hasta el banco como el principal obstáculo. Para el 61%, la principal razón para terminar la donación fue el final de la lactancia. Se asocia a mayor tiempo de donación tener un hijo a término, con peso mayor de 1.500 g, empezar pronto la donación y compatibilizar la donación con la situación laboral. CONCLUSIÓN: El perfil más común de donante es una mujer joven, universitaria y con pareja estable. El tener un recién nacido a término, iniciar antes la donación y compatibilizar la situación laboral con la donación incrementan el tiempo de donación. Recoger la leche en el domicilio facilitaría la donación a las mujeres

INTRODUCTION: The promotion of Human Milk Banks is an important social service. The Human Milk Banks depend on donors, and knowing the profile of donors seems quite important. OBJECTIVE: To study the demographics and lifestyles of the donors, the reasons or influences for donating, and to associate these variables with the length of the donation. METHODS: This is a descriptive, cross-sectional study conducted on 168 mothers who answered the written questionnaire when they agreed to become donors. 98 (58%) responded to the telephone interview. RESULTS: The mean age was 33.1±4.5 years. Of the total 27.9% lived outside Madrid and 21.4% were immigrants, with 23.7% working full time, 65.3% had a university education, and 96.2% had a stable partner. The main reasons for donating were too much milk (77%), and to help others (75%). The main obstacle was transportation to the Human Milk Bank for 20% of the donors, and for 61% the main reason for terminating donation was due to reaching the end of lactation. A longer donation is associated with: having a term newborn, with birth weight over 1500g, starting donating early and reconciling the donation to the work situation. CONCLUSION: The most common donor profile was a young woman, with university education and a stable partner. Having a term new born, starting donating early, and the conciliation with work is associated with longer donations. Milk pick-up at home would make donation easier

[Initial signs and symptoms of brain tumors in children]. / Síntomas y signos iniciales de los tumores cerebrales pediátricos.

INTRODUCTION: This is a study of the presenting features of brain tumors in children, their localization and histology which is aimed at describing the most frequent symptoms at the beginning and at the moment of diagnosis and minimize the time needed to reach a diagnosis. METHODS: Retrospective and descriptive study. Data were collected from the medical records of the patients (aged: 0-16) operated on for a brain tumor in our Department from 1999 to 2004. All analyses were conducted with the SPSS 11.0. RESULTS: In our study, the prevalence of brain tumors was higher in males (58%) older than five years. Of these, 52% were supratentorial and the most frequent one was astrocytome. Median time to diagnosis was 30 days. A total of 75% were diagnosed during the first 60 days of the onset of the symptoms. We found a statistically significant relationship between age and mean time to d i a gnosis. The most frequent initial symptom was increased head circumference and nausea/vomiting in children younger than 2 years, vomiting and headache in children aged 2-5, and headache in older than 5 years. In all groups, 83% of headache was accompanied by vomiting. CONCLUSIONS: Mean time to diagnosis in our study is similar to other series. Presenting features vary based on age and they are not pathognomonic of the brain tumors. This hinders early diagnosis. In order to make an early diagnosis, it is important to pay attention to the associated symptoms and chronology.

Puesta en marcha del banco de leche materna donada en una unidad neonatal / Setting up a donor milk bank within a neonatal unit

La leche materna es el alimento de elección para todos los recién nacidos. Cuando no hay suficiente leche de madre propia, la leche donada es la mejor alternativa. Hay numerosos bancos de leche en Europa, Estados Unidos, Australia, Centroamérica y Sudamérica. En 2007 abrió sus puertas el segundo banco de leche humana del Hospital 12 Octubre (BLHDO) de España, en su Servicio de Neonatología. No hay recomendaciones internacionales acerca del funcionamiento de un banco de leche, pero internacionalmente hay varias asociaciones de bancos de leche, cada una con sus guías de actuación; en el BLHDO se decidió seguir el modelo brasileño, ya que aporta parámetros de calidad, y no sólo de seguridad de la leche, comunes con la industria alimentaria. Al no haber legislación que regule la donación de leche se siguen las guías de otros bancos de leche y se han establecido sistemas de seguridad y de trazabilidad igual de estrictos que para la donación de sangre. En este artículo se comentan los distintos procedimientos que se llevan a cabo en el BLHDO, la experiencia de este primer año y los proyectos futuros de éste (AU)

Breast milk is the best choice to feed premature and ill babies, but when there is not enough mother milk available donor breast milk is the best alternative. Nowadays, Milk Banks are present worldwide. In December 2007 the second Spanish Milk Bank opened within the Department of Neonatology of the Hospital 12 Octubre, Madrid (BLHDO). There are no international recommendations for processing breast milk, therefore other Milk Banks guidelines are the only standards to follow. BLHDO uses the Brazilian model as they focus on milk quality, in addition to safety issues. Lack of legislation for human milk processing in Spain has led to BLHDO complying with Spanish Law on blood and tissues donation with its strict regulations on safety issues and record keeping. This article summarises the first year of operating the BLHDO and its future projects and developments (AU)

Síntomas y signos iniciales de los tumores cerebrales pediátricos / Initial signs and symptoms of brain tumors in children

tumores cerebrales en niños, sus características histológicasy su localización con el fin de conocer los síntomasmás habituales al inicio y en el momento del diagnóstico eintentar disminuir el tiempo hasta éste.Métodos. Estudio retrospectivo, descriptivo. Informaciónrecogida de las historias clínicas de 50 pacientes pediátricosintervenidos en nuestro centro de tumor cerebral primarioentre 1999 y 2004 analizada con SPSS 11.0.Resultados. En nuestra serie los tumores cerebralesfueron más prevalentes en niños (58%) mayores de 5 años,un 52% era supratentorial y el astrocitoma fue el más frecuente.La mediana de tiempo al diagnóstico fue de 30 díasy el 75% se diagnosticaron en los 60 días siguientes a la primeraconsulta. Encontramos una relación estadísticamentesignificativa entre el tiempo transcurrido hasta el diagnósticoy la edad. La clínica más frecuente en el diagnóstico eraaumento del perímetro craneal y náuseas/vómitos en losmenores de 2 años, náuseas/vómitos y cefalea en los niñosde 2 a 5 años y cefalea en los mayores de 5 años. En todoslos grupos el 83% de las cefaleas se acompañaban de náuseas/vómitos.Conclusiones. El tiempo medio hasta el diagnóstico ennuestra serie es aceptable comparado con otras. La clínicavaría en función de la edad y no es patognomónica de lostumores cerebrales, lo que dificulta el diagnóstico precoz.Para un diagnóstico precoz es importante fijarse en la asociaciónde síntomas y en la cronología (AU)

Introduction. This is a study of the presenting featuresof brain tumors in children, their localization andhistology which is aimed at describing the most frequentsymptoms at the beginning and at the moment of diagnosisand minimize the time needed to reach a diagnosis.Methods. Retrospective and descriptive study. Datawere collected from the medical records of the patients(aged: 0-16) operated on for a brain tumor in our Departmentfrom 1999 to 2004. All analyses were conductedwith the SPSS 11.0.Results. In our study, the prevalence of brain tumorswas higher in males (58%) older than five years. Of these,52% were supratentorial and the most frequent onewas astrocytome. Median time to diagnosis was 30 days.A total of 75% were diagnosed during the first 60 daysof the onset of the symptoms. We found a statisticallysignificant relationship between age and mean time to diagnosis.The most frequent initial symptom was increasedhead circumference and nausea/vomiting in childrenyounger than 2 years, vomiting and headache in childrenaged 2-5, and headache in older than 5 years. In allgroups, 83% of headache was accompanied by vomiting.Conclusions. Mean time to diagnosis in our study issimilar to other series. Presenting features vary based onage and they are not pathognomonic of the brain tumors.This hinders early diagnosis. In order to make anearly diagnosis, it is important to pay attention to theassociated syntoms and chronology (AU)

Piomiositis en los niños: no sólo una enfermedad tropical / Pyomyositis in children: not only a tropical disease

Introducción La piomiositis es una infección bacteriana aguda del músculo esquelético estriado, típica de países tropicales pero infrecuente en España. El objetivo de esta revisión es describir las características clínicas, epidemiológicas, etiológicas y diagnósticas en pacientes afectados de piomiositis. Material y métodos Se revisaron las historias de los pacientes diagnosticados de piomiositis en nuestro centro entre 2002 y 2005, recogiendo variables epidemiológicas, clínicas, analíticas, microbiológicas, terapéuticas y medios de diagnóstico. Se realizó un análisis descriptivo de las mismas. Resultados Se recogieron 7 casos (5 varones y 2 mujeres). La media de edad fue 8,6 años. Cinco de los casos (70 %) ocurrieron en los 6 meses de más calor. Hubo cuatro casos secundarios (una infección por el virus de la inmunodeficiencia humana, tres con antecedente traumático). Las localizaciones más frecuentes fueron la región del iliopsoas y el muslo. El dolor y la fiebre fueron los principales síntomas de inicio. La prueba de imagen más utilizada fue la ecografía, si bien la más rentable resultó ser la resonancia magnética, con una sensibilidad del 100 % frente al 33 % de la primera. El germen de mayor prevalencia en nuestra serie fue el Staphylococcus aureus (3/7). Sólo dos abscesos se drenaron quirúrgicamente y el resto se trató exclusivamente con antibioterapia, primero intravenosa seguida de oral. Ninguno de nuestros pacientes ha presentado secuelas. Conclusiones Ante todo niño con fiebre, dolor y/o impotencia funcional debemos considerar la piomiositis como posible entidad dentro del diagnóstico diferencial, a pesar de que ésta sea una enfermedad poco frecuente en España. La prueba diagnóstica más rentable es la RM. Si el tratamiento se realiza de forma precoz y eficaz, la evolución es buena

Introduction Pyomyositis is an acute bacterial infection of skeletal striated muscle typical of tropical countries but infrequent in our environment. The present review aims to describe the clinical characteristics, epidemiology, etiology, diagnosis and outcome of patients with pyomyositis in our hospital. Material and methods The medical records of patients diagnosed with pyomyositis in our hospital from 2002 to 2005 were reviewed. Epidemiological, clinical, and microbiological data as well as the diagnostic tests and treatment strategies used were gathered and a descriptive analysis was performed. Results There were seven patients (five boys and two girls). The mean age of the patients was 8.6 years. Five patients (70 %) presented during the 6 warmer months. There were four secondary cases (one HIV infection, three musculoskeletal injuries). The most frequent sites were the psoas-iliac region and thigh. The main symptoms at presentation were pain and fever. The most common diagnostic imaging modality was ultrasound examination, although magnetic resonance imaging had the highest diagnostic yield (sensitivity of 100 % versus 33 % for ultrasound). The most prevalent microorganism in our series was Staphylococcus aureus (found in three out of seven patients). Only two abscesses were surgically drained and the remainder were treated with antibiotics alone, first intravenously (mean of 17 days) and then orally (mean of 26 days). None of our patients developed sequelae. Conclusions Pyomyositis should be included in the differential diagnosis in children with fever, pain and/or functional impotence, even though this entity is infrequent in our environment. The most sensitive diagnostic test is magnetic resonance imaging. With early diagnosis and correct treatment, outcome is good

Residentes de Pediatría en Atención Primaria: 5 años de rotación obligatoria en el Área 11 de Madrid / Residents in pediatrics in primary care centers: 5 years of compulsory rotationin Health Area 11 of Madrid

Introducción Actualmente, la rotación por Atención Primaria de los Residentes de Pediatría no se realiza de forma sistemática. El objetivo de este estudio es dar a conocer la experiencia de tutores y residentes en relación a esta rotación, que desde hace 5 años es obligatoria para los residentes del Hospital 12 de Octubre de Madrid. Métodos Estudio observacional, descriptivo, transversal, realizado mediante encuesta en junio de 2005 a los 12 tutores acreditados y a los 38 residentes que han rotado. Resultados El 68 % de los residentes no conocía el funcionamiento de los Centros de Salud. Consideraron el primer año como el mejor para la rotación el 84 %. Un 65 % elegirían el Centro en función del tutor y el 97 % destacaba la implicación docente del mismo. Tutores y residentes opinaron que era escasa la duración (mes y medio). Todos creían que se alcanzaban los objetivos generales y reconocían la importancia de la rotación. Los tutores vivieron su labor docente como gratificante y estaban de acuerdo en que se debería compensar con reconocimiento profesional o mayor accesibilidad docente. Sería deseable mejorar la coordinación con la comisión de docencia de Pediatría del Hospital. Conclusiones La rotación rutinaria por Atención Primaria es posible y una experiencia positiva para la formación del pediatra. Residentes y tutores consideran que es satisfactoria y se ajusta a los objetivos marcados. Sería deseable crear la figura en Primaria de un coordinador docente, mayor duración de la rotación y alguna forma de reconocimiento a la labor de tutor

Introduction Currently, primary care center rotation is not compulsory for residents in pediatrics. The aim of this study was to describe the experience of tutors and residents during primary care rotation, which has been compulsory for residents in the Hospital 12 Octubre in Madrid for the last 5 years. Methods We performed an observational, descriptive, cross-sectional study through a survey carried out in June 2005 of 12 accredited tutors and 38 residents. Results Sixty-eight percent of the residents did not know how primary care centers worked. Eighty-four percent of the residents considered that the first year of residence was the best year for rotation in primary care, 64 % would choose the center according to the tutor, and 97 % highlighted the teaching of the tutors. Tutors and residents believed that the length of the rotation (1.5 months) was short. All tutors and residents thought that the main objectives were achieved and recognized the importance of the rotation. Tutors found teaching gratifying and all agreed that their work should be compensated by professional recognition or greater access to training. Coordination with the hospital's pediatric teaching board should be improved. Conclusions Compulsory rotation in primary care is feasible and is a positive component of pediatrics training. Residents and tutors considered this experience to be satisfactory and well adapted to the established objectives. The position of teaching coordinator should be created in primary care, the length of rotations prolonged and tutors' work should be compensated