Pulsioximetría frente al monitor de electrocardiograma para la determinación de la frecuencia cardíaca durante la reanimación del recién nacido pretérmino / Pulse oximetry versus electrocardiogram for heart rate assessment during resuscitation of the preterm infant

INTRODUCCIÓN: La medición de frecuencia cardíaca (FC) es esencial durante la reanimación neonatal y se realiza habitualmente mediante auscultación o pulsioximetría (PO). El objetivo de este estudio es analizar si durante la reanimación del recién nacido prematuro la medición de la FC mediante ECG es tan precoz y fiable como la PO. MATERIAL Y MÉTODOS: Se realizó video-grabación de la reanimación de 39 recién nacidos prematuros (<32 semanas o <1.500g), registrando medidas de FC simultáneamente mediante ECG y PO cada 5 s desde el nacimiento hasta los 10 min de vida. Se determinó el tiempo necesario para colocación, obtención de lectura fiable y pérdida de señal de ambos dispositivos, así como la proporción de medida fiable de FC al inicio de cada maniobra de reanimación. RESULTADOS: El tiempo de colocación fue menor en ECG que en PO (17,10±1,28 s vs. 26,64±3,01 s; p < 0,05). Igualmente, el tiempo desde el fin de la colocación hasta la obtención de una lectura fiable fue menor para ECG que para PO (26,38±3,41 s vs. 87,28±12,11 s; p < 0,05). La proporción de medidas fiables de la FC al inicio de la reanimación fue menor en PO (PO vs. ECG para ventilación con presión positiva: 10,52 vs. 57,89%; p < 0,05; intubación: 33,33 vs. 91,66%; p < 0,05). La PO subestimó la FC con medidas inferiores a las del ECG durante los primeros 6 min de vida (p < 0,05 entre los 150 y 300 s). CONCLUSIONES: En la reanimación del prematuro la obtención de la FC fiable es más tardía con la PO que con ECG; además, la PO subestima la FC en los primeros momentos de la reanimación

BACKGROUND: Heart rate (HR) assessment is essential during neonatal resuscitation, and it is usually done by auscultation or pulse oximetry (PO). The aim of the present study was to determine whether HR assessment with ECG is as fast and reliable as PO during preterm resuscitation. MATERIAL AND METHODS: Thirty-nine preterm (<32 weeks of gestational age and/or<1.500g of birth weight) newborn resuscitations were video-recorded. Simultaneous determinations of HR using ECG and PO were registered every 5s for the first 10min after birth. Time needed to place both devices and to obtain reliable readings, as well as total time of signal loss was registered. The proportion of reliable HR readings available at the beginning of different resuscitation manoeuvres was also determined. RESULTS: Time needed to connect the ECG was shorter compared with the PO (26.64±3.01 vs. 17.10±1.28 s, for PO and ECG, respectively, P<.05). Similarly, time to obtain reliable readings was shorter for the ECG (87.28±12.11 vs. 26.38±3.41 s, for PO and ECG, respectively,P<.05). Availability of reliable HR readings at initiation of different resuscitation manoeuvres was lower with the PO (PO vs. ECG for positive pressure ventilation: 10.52 vs. 57.89% P<.05; intubation: 33.33 vs. 91.66%, P<.05). PO displayed lower HR values during the first 6min after birth (P<.05, between 150 and 300s). CONCLUSIONS: Reliable HR is obtained later with the PO than with the ECG during preterm resuscitation. PO underestimates HR in the first minutes of resuscitation

[Pulse oximetry versus electrocardiogram for heart rate assessment during resuscitation of the preterm infant]. / Pulsioximetría frente al monitor de electrocardiograma para la determinación de la frecuencia cardíaca durante la reanimación del recién nacido pretérmino.

BACKGROUND: Heart rate (HR) assessment is essential during neonatal resuscitation, and it is usually done by auscultation or pulse oximetry (PO). The aim of the present study was to determine whether HR assessment with ECG is as fast and reliable as PO during preterm resuscitation. MATERIAL AND METHODS: Thirty-nine preterm (<32 weeks of gestational age and/or<1.500g of birth weight) newborn resuscitations were video-recorded. Simultaneous determinations of HR using ECG and PO were registered every 5s for the first 10min after birth. Time needed to place both devices and to obtain reliable readings, as well as total time of signal loss was registered. The proportion of reliable HR readings available at the beginning of different resuscitation manoeuvres was also determined. RESULTS: Time needed to connect the ECG was shorter compared with the PO (26.64±3.01 vs. 17.10±1.28 s, for PO and ECG, respectively, P<.05). Similarly, time to obtain reliable readings was shorter for the ECG (87.28±12.11 vs. 26.38±3.41 s, for PO and ECG, respectively, P<.05). Availability of reliable HR readings at initiation of different resuscitation manoeuvres was lower with the PO (PO vs. ECG for positive pressure ventilation: 10.52 vs. 57.89% P<.05; intubation: 33.33 vs. 91.66%, P<.05). PO displayed lower HR values during the first 6min after birth (P<.05, between 150 and 300s). CONCLUSIONS: Reliable HR is obtained later with the PO than with the ECG during preterm resuscitation. PO underestimates HR in the first minutes of resuscitation.

Refractory pyoderma gangrenosum treated with infliximab in an infant.

We report the case of an 11-month-old boy with severe recalcitrant pyoderma gangrenosum refractory to prednisone, dapsone and ciclosporin. Treatment with infliximab was well tolerated, and resulted in an excellent clinical response that has been sustained for 15 months. The characteristics of this condition in children and the use of infliximab in infants are both reviewed.

Comparison of the primary stabilities of conical and cylindrical endosseous dental implants: an in-vitro study.

The aim of this study is to determine the differences in primary stability between conical and cylindrical dental implants. The insertion and removal torques were the parameters used to measure the primary stability of the implants. Ten conical and cylindrical dental implants were positioned in polyurethane foam blocks to simulate bone density classes D1, D2, D3 and D4. The insertion and removal torques were quantified using a digital torque gauge. The maximum insertion torque and the maximum removal torque measured for the D1 and D4 synthetic bone were significantly higher for the conical implants than the cylindrical implants. In this in-vitro model, conical implants show significantly higher primary stability than cylindrical implants for the D1 and D4 synthetic bone classes.

Early evaluation of immune reconstitution following allogeneic CD3/CD19-depleted grafts from alternative donors in childhood acute leukemia.

Graft engineering procedures for hematopoietic SCT (HSCT) may improve the chance of success in matched unrelated donor (MUD) and haploidentical donor transplantations. Successful donor immune reconstitution is important to mediate GVL effects in reduced-intensity conditioning (RIC) HSCT. We prospectively investigated early immune reconstitution and clinical outcome in 30 CD3/CD19-depleted MUD (n=15) or HP (n=15) HSCTs for high-risk childhood leukemia using a fludarabine-based RIC without serotherapy. The graft consisted of a mean of 10.5 × 10(6)/kg CD34+, 77 × 10(3)/kg CD3+ and 39 × 10(6)/kg CD56+ cells. After transplantation, 86% of the patients engrafted. In all, 13% of patients had >grade 3 acute GVHD. Natural killer (NK) cell, DC and T-cell recovery achieved normal values within the first 60 days after transplantation. DC recovery was dominated by the DC2(-) subset. NK-cell phenotype was altered and cytotoxicity was lower compared with their donors. EFS was 50±9% (73±11% for those in CR1 and 26±11% for those with advanced disease). Faster DC2(-) recovery was associated with better outcome, especially in the MUD setting. In summary, CD3/CD19-depleted HSCT with fludarabine-based RIC without serotherapy resulted in favorable patient survival, and rapid NK, DC and T-cell recovery.

[Multimodality imaging of chronic tophaceous gout]. / Imaging integrato nella gotta cronica tofacea.

The diagnosis of gout is usually based on clinical presentation and laboratory findings. Imaging plays a role in the assessment and grading of articular damage related to chronic, long-standing disease, which is characterized by granulomatous synovitis, tophi, and erosions. Multimodality imaging of chronic tophaceous gout may be useful in clinical practice for a variety of purposes, including assessment of disease-related anatomical changes and monitoring of articular and soft-tissue lesions over time, especially in response to urate-lowering therapy. Radiography remains the primary imaging technique. Ultrasonography may detect monosodium urate crystals on cartilage, is helpful to assess small joint effusion, to guide to joint aspiration, and to evaluate the volume of tophi. Computed tomography is considered to be more sensitive than plain radiography in the detection and evaluation of cortical bone erosions associated with tophi. MRI represents the only imaging modality which provides visualization of bone marrow oedema associated with erosions and may be useful to characterize and distinguish tophi from other soft tissue nodules.

Caspase activation and apoptosis in response to proteasome inhibitors.

Several studies have indicated that proteasome inhibitors (PIs) are promising anticancer agents. We have discovered that PIs have the unique ability to activate effector caspases through a mitochondrial Bcl-2 inhibitable but caspase-9 independent pathway. Stabilization of released Smac induced by blockade of the proteasome could explain the apoptosome-independent cell death induced by PIs. In fact, Smac/DIABLO critically supports this PIs-dependent caspase activation. By using a new assay, we confirm that at a single cell level both Smac and PIs can activate caspases in the absence of the apoptosome. Moreover, we have observed two PIs-induced kinetics of caspase activation, with caspase-9 being still required for the rapid caspase activation in response to mitochondrial depolarization, but dispensable for the slow DEVDase activation. In summary, our data indicate that PIs can activate downstream caspases at least in part through Smac/DIABLO stabilization.

Meningitis por 'H. influenzae' no tipificable en un niño vacunado previamente contra el tipo b / Meningitis caused by non-typable H. influenzae in a previously immunized child

Tras la introducción de la vacunación masiva contra Haemophilus influenzae (HI) tipo b, el número de infecciones por este serotipo ha disminuido, aumentando las infecciones causadas por otros serotipos de HI y por HI no tipificable. Presentamos un caso de meningitis por Haemophilus influenzae no tipificable en un niño que previamente había recibido la vacuna de polisacáridos capsulados contra H. influenzae tipo b. Su evolución clínica fue satisfactoria recibiendo tratamiento antibiótico con cefotaxima durante 10 días. El paciente no presentó complicaciones neurológicas ni de otro tipo durante su ingreso ni en su seguimiento posterior. La incidencia de infecciones por HI no tipificable parece que está aumentando en nuestro medio, aunque no se ha establecido todavía de manera clara su importancia relativa y son necesarios estudios más amplios para determinar dicha incidencia (AU)