A multi-centre, open-label, prospective, observational study to assess the safety of a nifedipine oral solution in the treatment of preterm labor / Estudio multicéntrico, de diseño abierto, prospectivo y observacional para evaluar la seguridad de una solución oral de nifedipino en el tratamiento del parto prematuro

Objective: To analyze the safety profile of a nifedipine oral solution in the treatment of preterm labor (PTL). Methods: A multi-center, open-label, prospective, single-arm, observational study was conducted in 500 women with PTL to whom a nifedipine oral solution was prescribed according to its Summary of Product Characteristics. Safety profile and tolerability of oral administration of nifedipine solution during routine clinical practice was assessed as the primary objective of the study and treatment efficacy as secondary objective. Results: No severe adverse events were reported among these women, including severe hypotension. Eight patients (2.3%) reported adverse reactions of moderate intensity, and in 0.9% of the patients (3 cases), these adverse reactions caused the discontinuation of the treatment. Conclusions: The results of this study show that nifedipine oral solution exhibits an excellent safety profile used as a tocolytic treatment in women with PTL.(AU)

Objetivo: Analizar el perfil de seguridad de una solución oral de nifedipino en el tratamiento del parto prematuro (PP). Métodos: Se llevó a cabo un estudio observacional, prospectivo, de diseño abierto, de rama única y multicéntrico en 500 mujeres que presentaban un PP, a las que se les administró una solución oral de nifedipino según la ficha técnica del producto. El perfil de seguridad y la tolerancia de la solución oral de nifedipino, en el contexto de la práctica clínica rutinaria, fueron evaluados como objetivo primario del estudio, y la eficacia del tratamiento, como objetivo secundario. Resultados: No se notificaron efectos adversos graves, incluyendo hipotensión severa. Ocho pacientes (2,3%) presentaron reacciones adversas de intensidad moderada, y en el 0,9% de las pacientes (3 casos) estos efectos adversos provocaron la discontinuación del tratamiento. Conclusiones: Los resultados de este estudio muestran que la solución oral de nifedipino dispone de un excelente perfil de seguridad para su uso como tocolítico en el tratamiento de mujeres con PP.(AU)

The first-year course of urine MCP-1 and its association with response to treatment and long-term kidney prognosis in lupus nephritis.

OBJECTIVES: The present study aims to assess the course of uMCP-1 and its association with response to therapy and long-term kidney function in a prospective cohort of adults who received a kidney biopsy for suspicion of active lupus nephritis (LN). METHODS: Subjects were segregated into a histologically active LN group and a histologically chronic LN group. Both groups were followed for > = 36 months and urine were collected at flare, 3, 6, and 12 months of follow-up. The association between the course of uMCP-1, response to treatment, and progression to 30% loss of the eGFR was evaluated by linear mixed models for repeated measures. RESULTS: A kidney biopsy was performed on 125 subjects. In 114, the report was consistent with histologically active LN; in 11, with histologically chronic LN. Urine MCP-1 levels were significantly higher in the active LN than in the chronic LN group. Urine MCP-1 levels correlated with the histological findings of cellular crescents, endocapillary hypercellularity, interstitial inflammation, glomerular sclerosis, interstitial fibrosis, and tubular atrophy. The mean estimates of uMCP-1 at flare were higher in the non-response group than in the complete response group, and decreased in the complete/partial response groups by the third month, while they remained elevated in the non-response group. The mean estimates for uMCP-1 were higher at LN flare and remained elevated in patients who progressed to loss of 30% of the eGFR, while they decreased in patients with stable kidney function. CONCLUSION: The first-year course of uMCP-1 is associated with response to therapy and kidney survival in LN. Key Points •Urine MCP-1 levels differentiate histologically-active lupus nephritis from histologically-chronic lupus nephritis •Urine MCP-1 levels decrease by 3 months of therapy in subjects with a favorable response whose kidney function remains stable long-term •Urine MCP-1 levels remain elevated during the first year of therapy in subjects the will later lose kidney function.

Exclusive breastfeeding promotion policies: whose oxygen mask are we prioritizing?

Provision of human milk is crucial for maternal and infant health. However, exclusive breastfeeding may exacerbate mood disorders in women unable to achieve this goal. A nuanced approach that considers all aspects of maternal and infant health is needed. In this paper, we bring attention to the potentially negative consequences on maternal and infant health that may be associated with exclusive breastfeeding in the setting of significant challenges. We discuss recent literature exploring the relationship between breastfeeding and maternal mental health, and contextualize it with our first-hand experiences as healthcare professionals who aimed to exclusively breastfeed and encountered difficulties. Given existing evidence and our collective anecdotal experience, we advocate for a balanced approach when supporting parents struggling to breastfeed. Timely recommendations are offered for healthcare providers, medical educators and hospital administrators seeking to balance maternal and infant child health considerations while continuing to promote breastfeeding. PRéCIS STATEMENT: Exclusively promotion of breastfeeding impacts maternal mental health and consequently, infant health. We advocate for balanced considerations of maternal and infant child health while promoting breastfeeding. CLINICAL IMPLICATIONS: Singular promotion of exclusive breastfeeding may exacerbate adverse maternal mental health outcomes. A balanced consideration of maternal and infant child health is vital as breastfeeding is encouraged. Clinicians who provide front-line support to breastfeeding parents must be taught and expected to provide nuanced breastfeeding support that anticipates both physical and mental health challenges.

Prevalence and temporal trends of anemia in patients with heart failure.

BACKGROUND: Anemia is an important comorbidity in heart failure (HF), and it is associated with increased adverse disease experience and mortality. Previous reports have focused mainly on HF presenting in healthcare settings. We, therefore, set out to establish the nationwide prevalence and temporal trends of anemia in community-based patients with HF in the US. AIM: To establish the nationwide prevalence and temporal trends of anemia in community-based patients with HF in the US. DESIGN: The NHANES dataset, conducted by the CDC National Center for Health Statistics was used to collect nationally representative data on the health and nutritional status of the non-institutionalized US population. METHODS: We utilized the National Health and Nutrition Examination data collected over five survey cycles (2007-16). Included were participants aged 20-80 years with self-reported diagnosis of HF. Anemia was defined using 2 sex specific cut offs of 13 and 12 g/dl (cutoff 1), and 12 and 11 g/dl (cutoff 2), for men and women, respectively. The Chi square test was used to compare prevalence across different categories and survey cycles. Data analysis was done using STATA 16 with P-values < 0.05 considered statistically significant. RESULTS: The median hemoglobin in all HF patients was 13.5 g/dl (IQR 12.4-14.5). The prevalence of anemia among community-based patients with HF in the US was 21.34% (cutoff 1) and 9.03% (cutoff 2) and has been stable from 2007 to 2016. The burden of anemia was disproportionately higher in NH Blacks (34.48%, 95% CI 27.12-42.67) and those with BMI < 25 Kg/m2 (17.4%, 95% CI 10.9-26.64). CONCLUSION: The prevalence of anemia in patients with HF in the US is at least 9% and has remained stable over the past decade. This high persistent burden with limited proven interventions should spur further efforts aimed at identifying impactful ways of addressing anemia in patients with HF.

Mycobacterium chimaera in heater-cooler devices: an experience in a tertiary hospital in Spain.

The aim of the study was to describe the Mycobacterium chimaera contamination in heater-cooler devices after the application of a protocol of cleaning and disinfection in a tertiary hospital. It was an observational study at the La Paz-Cantoblanco-Carlos III University Hospital, Madrid, Spain. Seven heater-cooler devices are used in our hospital: five 3T Sorin (LivaNova) and two Maquet. We followed the manufacturers' instructions for cleaning and disinfection of the different heater-cooler devices. Environmental testing was developed monthly from January 2017 to July 2019. Samples were obtained from both cardioplegia and patient circuits and before and after the disinfection process and were cultured in appropriate media for non-tuberculous mycobacteria and heterotrophic bacteria (coliforms and Pseudomonas aeruginosa). A total of 320 samples were taken. Mycobacterium chimaera grew in four water samples (1.25%) from three different heater-cooler devices, with two positive results occurring after disinfection. The heterotrophic bacteria Delftia acidovorans and Stenotrophomonas maltophilia were also found. There has not been a case of M. chimaera infection in patients after cardiac surgery in our hospital. In March 2019, we decided to move the heater-cooler device outside the operating room. Mycobacterium chimaera contamination is not always eradicated by disinfection processes. We believe that placing 3T heater-cooler devices outside the operating room is the best option in preventing M. chimaera infection during cardiac surgery.

Cervical consistency index and risk of Cesarean delivery after induction of labor at term.

OBJECTIVE: To evaluate the association between the cervical consistency index (CCI) and the risk of Cesarean delivery after planned induction of labor (IOL) at term. METHODS: This was a prospective observational study of women with a term singleton pregnancy admitted for IOL due to maternal or fetal indication. Ultrasonographic images were obtained before IOL and CCI was calculated offline once recruitment was completed. The main outcome was defined as Cesarean delivery due to failed IOL or arrest of labor. Cesarean deliveries indicated due to maternal or fetal compromise (Van Dillen's grade 1 or 2) were excluded from analysis. Univariate statistical analysis was performed using Fisher's exact test and Student's t-test for categorical and continuous variables, respectively. Multivariate analysis was performed using logistic regression, including CCI and other variables related to the main outcome. Intraclass correlation coefficients were used to estimate intra- and interobserver agreement. RESULTS: Of 510 women admitted for IOL during the study period and for whom image quality was adequate, 46 were excluded due to emergency Cesarean delivery leaving 464 pregnancies for analysis. Cesarean section due to failed IOL or arrest of labor was performed in 100/464 (21.6%) pregnancies. The mean CCI of women who underwent Cesarean delivery was not significantly different from that in those who had vaginal delivery after IOL (70.1 ± 12.3% vs 70.0 ± 13.1%; P = 0.94). Multivariate analysis also showed absence of statistical association between CCI and Cesarean delivery for failed IOL or arrest of labor. Intraclass correlation coefficients for intra- and interobserver agreement were 0.81 (95% CI, 0.66-0.89) and 0.86 (95% CI, 0.75-0.92), respectively. CONCLUSION: CCI does not seem to be associated with the risk of Cesarean delivery after IOL. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Comparative in vitro study of the accuracy of impression techniques for dental implants: Direct technique with an elastomeric impression material versus intraoral scanner.

BACKGROUND: The aim of this study was to compare a conventional technique (elastomeric impression material - EIM) and a digital technique (scanner digital model - SDM) on a six-analog master model (MM) to determine which was the most exact. MATERIAL AND METHODS: Twenty impressions were taken of a master model (EIM) and twenty scanned impressions (SDM) (True Definition). A coordinate measuring machine (CMM) was used to measure the distances between adjacent analogues (1-2, 2-3, 3-4, 4-5, 5-6), intermittently positioned analogues (1-4, 3-6) and the most distal (1-6). Reference values were established from the master model, which were compared with the two impression techniques. The significance level was established as 5% (p<0.05). RESULTS: The precision of each technique was compared with MM. For adjacent analogues (1-2), no significant differences were found between EIM-MM (p=0,146). For intermittently positioned analogues (1-4), SDM did not show significant differences with MM (p=0.255). For the distance between distal analogues (1-6), significant differences were found between both techniques and MM (p=0.001). CONCLUSIONS: In a clinical situation with < three implants, EIM is more exact than SDM, but in cases of four implants SDM is more exact. For rehabilitations (> four implants), neither technique can be considered accurate although error falls within the tolerance limits established in the literature (30-150µm).

Lynx eats cat: disease risk assessment during an Iberian lynx intraguild predation.

Lethal interactions between members of the carnivore guild are well represented in literature. In the Iberian lynx, interspecific killing (without prey consumption) of some mesocarnivores, such as the Egyptian mongoose, genet, and red fox, has been reported. Although vaguely documented, evidence suggests feral cats fall victim to interactions with this apex predator. Here, we describe the first documented case of interspecific killing and partial consumption of a feral cat by an adult male Iberian lynx reintroduced in Southwestern Spain. Ulterior analyses demonstrated that the victim was viremic to feline leukemia virus. To prevent the dissemination of the virus and a potential outbreak in the Iberian lynx population, control measures, including the clinical evaluation of the male Iberian lynx, and intensive monitoring were implemented in order to detect intraspecific interactions. After 3 weeks, the lynx was evaluated, presented good condition and resulted negative to both ELISA and RT-PCR. Thanks to the long-term monitoring, this case could be detected and measures to prevent an outbreak could be implemented.

Evaluación del grosor de los músculos extraoculares y la quemosis tras tocilizumab en oftalmopatía de Graves mediante tomografía de coherencia óptica / Response to tocilizumab treatment in Graves' ophthalmopathy by measuring rectus muscle thickness and chemosis using optical coherence tomography

PROPÓSITO: Evaluar el grosor de los músculos extraoculares y la quemosis tras el tratamiento con tocilizumab en pacientes con oftalmopatía de Graves activa mediante tomografía de coherencia óptica. MÉTODOS: Serie de 5 casos con oftalmopatía de Graves activa (escala de actividad clínica ≥ 4/10) tratados mediante 4 dosis de tocilizumab. Estos pacientes habían sido tratados previamente con corticoides sin mejoría. Se empleó una tomografía de coherencia óptica de dominio espectral para determinar el grosor del recto lateral y del recto medial, y la quemosis antes y después de 4 dosis de tocilizumab administradas mensualmente. Se realizó el escaneado a las 3 y 9 h (nasal y temporal). RESULTADOS: Se estudiaron 4 mujeres y un hombre con una edad mediana de 52 años (rango: 38-73). La duración mediana de la actividad fue de 17 meses (rango: 12-18). El grosor muscular mediano del recto medial y del recto lateral pretratamiento fue 249 μm (174-366) y 337 μm (142-443) respectivamente, siendo la quemosis mediana 409 μm (290-610). Tras el tratamiento con tocilizumab el grosor muscular disminuyó a 157 μm (88-187) y 197 μm (99-290) respectivamente (p = 0,043; Wilcoxon), y la quemosis a 59 μm (0-78). La escala de actividad clínica disminuyó de 5 (4-8) a 1 (0-3). CONCLUSIONES: Se observó una reducción en el grosor muscular de los rectos horizontales y en la quemosis en pacientes con oftalmopatía de Graves tras el tratamiento con tocilizumab mediante tomografía de coherencia óptica, por lo que esta técnica podría ser útil para la valoración de la respuesta al tratamiento

PURPOSE: To assess the extraocular muscle thickness and chemosis after treatment with tocilizumab in patients with active Graves' ophthalmopathy by optical coherence tomography. METHODS: Case series of five patients with active Graves' ophthalmopathy (clinical activity score ≥ 4/10) treated with 4 doses of tocilizumab. These patients had been previously treated with corticosteroids with no response. Spectral-domain optical coherence tomography was employed to determine lateral and medial rectus muscle thickness and chemosis before and after 4 doses of tocilizumab given monthly. Scanning was performed at 3 and 9 o'clock (nasal and temporal). RESULTS: The study included four women and one man with a median age of 52 years (range: 38-73). Median Graves' ophthalmopathy activity duration was 17 months (12-18). Median medial rectus and determine lateral thicknesses pre-treatment were 249 μm (174-366) and 337 μm (142-443), respectively. Median chemosis was 409 μm (290-610). After tocilizumab treatment, median muscle thicknesses reduced to 157 μm (88-187) and 197 μm (99-290), respectively (P = .043; Wilcoxon) and chemosis to 59 μm (0-78). Median clinical activity score decreased from 5 (4-8) to 1 (0-3). CONCLUSIONS: A reduction in extraocular muscle thickness and chemosis was observed after treatment with tocilizumab in Graves' ophthalmopathy patients using an optical coherence tomography, so this technique could be a useful complementary technique to assess the therapeutic responses

Response to tocilizumab treatment in Graves' ophthalmopathy by measuring rectus muscle thickness and chemosis using optical coherence tomography. / Evaluación del grosor de los músculos extraoculares y la quemosis tras tocilizumab en oftalmopatía de Graves mediante tomografía de coherencia óptica.

PURPOSE: To assess the extraocular muscle thickness and chemosis after treatment with tocilizumab in patients with active Graves' ophthalmopathy by optical coherence tomography. METHODS: Case series of five patients with active Graves' ophthalmopathy (clinical activity score ≥4/10) treated with 4 doses of tocilizumab. These patients had been previously treated with corticosteroids with no response. Spectral-domain optical coherence tomography was employed to determine lateral and medial rectus muscle thickness and chemosis before and after 4 doses of tocilizumab given monthly. Scanning was performed at 3 and 9 o'clock (nasal and temporal). RESULTS: The study included four women and one man with a median age of 52 years (range: 38-73). Median Graves' ophthalmopathy activity duration was 17 months (12-18). Median medial rectus and determine lateral thicknesses pre-treatment were 249µm (174-366) and 337µm (142-443), respectively. Median chemosis was 409µm (290-610). After tocilizumab treatment, median muscle thicknesses reduced to 157µm (88-187) and 197µm (99-290), respectively (P=.043; Wilcoxon) and chemosis to 59µm (0-78). Median clinical activity score decreased from 5 (4-8) to 1 (0-3). CONCLUSIONS: A reduction in extraocular muscle thickness and chemosis was observed after treatment with tocilizumab in Graves' ophthalmopathy patients using an optical coherence tomography, so this technique could be a useful complementary technique to assess the therapeutic responses.

Fenotipo en pacientes con discapacidad intelectual y array-CGH patológico / Phenotype in patients with intellectual disability and pathological results in array CGH

Introducción: El retraso global del desarrollo (RGD) y la discapacidad intelectual (DI) son un motivo de consulta frecuente en la consulta de Neuropediatría. Actualmente, la hibridación genómica comparada constituye una de las principales técnicas aplicadas al diagnóstico de esta patología. Resulta útil determinar qué características fenotípicas se asocian a obtener un resultado etiológico en el test genético. Métodos: Se llevó a cabo un estudio ciego pormenorizado de las características clínicas, antropométricas y morfológicas de 80 individuos afectos de DI no explicada y se analizó cuales estaban asociadas a obtener un resultado etiológico en el array-CGH. Resultados: El resultado del array fue patológico en un 27,5% de los casos. Los factores que se asociaron estadísticamente a tener una prueba de array-CGH patológica fueron los antecedentes familiares de DI/RGD (OR: 12,1), la presencia de malformaciones congénitas (OR: 5,33), más de 3 rasgos dismórficos faciales (OR: 20,9) y la hipotonía periférica (OR: 3,25). Conclusiones: Nuestros hallazgos coinciden con otras series publicadas. Por lo tanto, asumimos que la probabilidad de encontrar variación en el número de copias de significado patológico mediante array-CGH aumenta si alguna de las características anteriores está presentes en individuos afectos de DI/RGD (AU)

Introduction: Global developmental delay (GDD) and intellectual disability (ID) are frequent reasons for consultation in paediatric neurology departments. Nowadays, array comparative genomic hybridisation (array-CGH) is one of the most widely used techniques for diagnosing these disorders. Our purpose was to determine the phenotypic features associated with pathological results in this genetic test. Methods: We conducted a blind study of the epidemiological, clinical, anthropometric, and morphological features of 80 patients with unexplained ID to determine which features were associated with pathological results in array-CGH. Results: Pathological results were found in 27.5% of the patients. Factors associated with pathological results in array-CGH were a family history of GDD/ID (OR = 12.1), congenital malformations (OR = 5.33), having more than 3 facial dysmorphic features (OR = 20.9), and hypotonia (OR = 3.25). Conclusions: Our findings are consistent with those reported by other published series. We therefore conclude that the probability of having pathological results in array-CGH increases with the presence of any of the features mentioned above in patients with ID/GDD (AU)

Prevalencia y duración de la lactancia materna en el medio rural / Prevalence and nutritional of maternal breastfeeding in the rural setting

Introducción y objetivos. A pesar del reconocimiento generalizado de los beneficios de la lactancia materna para la madre y el recién nacido en la mayoría de países no se alcanzan los niveles deseados El objetivo de este trabajo es evaluar la prevalencia, duración y motivos de abandono de la lactancia materna en un medio rural. Métodos. Se realizó un estudio prospectivo observacional durante un año de todos los recién nacidos en el hospital comarcal de Alcañiz, que se complementó con una encuesta sobre las características de la lactancia durante los primeros meses para rellenar y entregar por el pediatra o médico de familia de Atención Primaria. Resultados. Durante el periodo a estudio hubo 456 recién nacidos. Iniciaron lactancia materna el 96,9% de los neonatos, el 26.5% recibieron suplementos (por indicación médica o por petición de los padres). Al alta, el 84,7% se fueron con lactancia materna exclusiva. La duración media de la lactancia materna fue de cuatro meses y medio con una media de inicio de lactancia artificial a los dos meses y medio. El motivo más frecuente de abandono fue la decisión materna (44,5%). Conclusiones. Tenemos resultados muy positivos en cuanto al inicio de la lactancia materna, pero debemos seguir trabajando en la formación de los profesionales sanitarios y en la información a los padres para el mantenimiento de esta y en las causas de abandono, siendo estas la mayor parte de las veces modificables (AU)

Introduction and objectives. Despite of the knowledge of the benefits of breastfeeding for the mother and newborn, in most countries the desired levels are not reached. The objective of this study is to evaluate the prevalence, duration and reasons for abandoning breastfeeding in a rural setting. Methods. A prospective observational study was conducted for one year of all newborns in the hospital of Alcañiz, which was complemented by a survey on the characteristics of breastfeeding during the first months to be filled in and delivered by the paediatrician of primary care. Results. During the study period there were 456 new-borns. 96.99% of newborns started breastfeeding, 26.5 received supplements (either by medical indication or at the request of the parents). At discharge, 84.7% went on exclusive breastfeeding. The mean duration of breastfeeding was four and a half months with a mean of initiation of artificial breastfeeding at two and a half months. The most frequent reason for abandonment was the internal decision (44.5%). Conclusions. We have very positive results looking the initiation of breastfeeding, but we must continue working in the training of health professionals and in the information given to parents for promote the maintenance of this and decrease the reasons of abandonment, most of times modifiable (AU)

The efficacy and safety of estriol to treat vulvovaginal atrophy in postmenopausal women: a systematic literature review.

OBJECTIVES: To evaluate the efficacy and safety of estriol for the treatment of vulvovaginal atrophy in postmenopausal women. METHODS: A systematic literature review was performed. We searched the following electronic databases: Medline, Cochrane, Embase, Lilacs, CINHAL and Google Scholar. The studies selected included controlled clinical trials and quasi-experimental studies. Selections were made in pairs and independently, first by title and abstract and then complete texts. RESULTS: We identified 188 studies, 22 of which met the inclusion criteria; 13 were controlled clinical trials and nine were quasi-experimental, and 1217 women were included. These studies confirmed the efficacy of local estrogens to treat symptoms of vulvovaginal atrophy with few adverse effects reported. Following treatment, serum estriol levels rose, peaking at 1 h. At the 6-month follow-up, there was no increase in serum estriol in treated women. CONCLUSIONS: The available evidence (of low and moderate quality) shows that, when administered vaginally, estriol preparations appear to be safe for women who have risk factors related to systemic estrogen therapy.

Experiencia con la hoja de información de «epilepsia en la infancia» / Experience with the information sheet of «epilepsy in infancy»

Introducción. En la sección de neuropediatría, se trabaja con hojas de información que pretenden explicar de forma rigurosa los problemas y su seguimiento. La de «la epilepsia en la infancia» se entrega cuando existe sospecha o diagnóstico certero de epilepsia. Método. Se analiza, a través de unas encuestas, el grado de satisfacción y las percepciones de los padres o tutores que recibieron dicha hoja. Resultados. 658 pacientes recibieron la hoja de información desde febrero de 2012 hasta diciembre de 2014. La tasa de respuesta es del 56,8%. El 63,10% de los pacientes que recibieron la hoja de información tenían un diagnóstico definitivo de epilepsia. Un 92,7% está satisfecho de haber recibido la hoja. Solo un 0,3% de los pacientes hubiera preferido no recibir la hoja de información. Conclusiones. La mayoría de padres o tutores de los pacientes con sospecha o diagnóstico de epilepsia se mostraron satisfechos por recibir la hoja de información. La hoja de información de «epilepsia en la infancia» mejora la información y la satisfacción percibida y su evaluación para corregir y mejorar, es necesaria en el proceso de mejora que no tiene punto final (AU)

Introduction. In the Pediatric Neurology service, we work with fact sheets that aim to rigorously explain the problems and their follow—up. The «epilepsy in childhood» fact sheet is given when there is suspicion or accurate diagnosis of epilepsy. Methods. The degree of satisfaction and the perceptions of the parents or guardians who received this sheet were analyzed through surveys. Results. 658 patients received the fact sheet from February 2012 to December 2014. The response rate was 56.8%. 63.10% of the patients who received the information sheet had a definitive diagnosis of epilepsy. 92.7% are satisfied to have received the sheet. Only 0.3% of the patients would have preferred not to receive the fact sheet. Conclusion. The majority of parents or guardians of patients with suspected or diagnosed epilepsy were satisfied by receiving the fact sheet. The «epilepsy in childhood» fact sheet improves information and perceived satisfaction, and its evaluation (to correct and improve it) is necessary in the continua] improvement process (AU)

Taquicardia supraventricular tipo reciprocante AV incesante y refractaria a cardioversión (AU) / Incesant AV reciprocating supraventricular tachycardia refractory to cardioversion

La taquicardia paroxística supraventricular (TPSV) es la causa más frecuente de emergencia cardiovascular por arritmias en el niño. A pesar de que la mayoría se controlan gracias a las maniobras vagales o el tratamiento farmacológico de primera línea, ante inestabilidad hemodinámica requiere cardioversión sincronizada y estabilización en unidad de cuidados intensivos (AU)

Paroxysmal supraventricular tachycardia (SVT) is the most common cause of emergency cardiovascular by arrhythmias in children. Although most of them are controlled by vagal maneuvers or first—line drug treatment, hemodynamic inestability requires synchronized cardioversion and stabilization in intensive care unit (AU)

Evolución fatal por enterovirus A71 / Fatal evolution by enterovirus A71

El enterovirus (EV) A71 es un serotipo de EV aislado, hasta ahora, frecuentemente en infecciones banales en nuestro medio (síndrome febril, enfermedad mano-pie-boca, herpangina...). No era muy frecuente en nuestro país hasta el año 2012 cuando triplicó su incidencia. Últimamente se ha aislado asociando clínica neurológica grave, miocarditis o edema de pulmón y puntualmente exitus lo que ha provocado una alarma social generalizada (AU)

The enterovirus (EV) A71 is a serotype of EV isolated, until now, frequently in banal infections in our environment (febrile syndrome, hand foot mouth disease, herpangina...). It was not very frequent in our country until 2012 when its incidence tripled. Lately it has been isolated associating severe neurological clinic, myocarditis or pulmonary edema and punctually exitus which has provoked a widespread social alarm (AU)