Estudio de las epilepsias según la edad de inicio, controladas durante 3 años en una unidad de neuropediatría de referencia regional / A study of epilepsy according to the age at onset and monitored for 3 years in a regional reference paediatric neurology unit

OBJETIVO: Estudio de las epilepsias según la edad de inicio de las crisis y la etiología, de los pacientes controlados en una unidad de neuropediatría durante 3 años. PACIENTES Y MÉTODOS: Estudio de cohortes históricas. Revisión de historias de niños con epilepsia de la base de datos de neuropediatría controlados del 1 de enero de 2008 al 31 de diciembre de 2010. RESULTADOS: De 4.595 ni˜nos atendidos en el periodo, se estableció el diagnóstico de epilepsia en 605 (13,17%), siendo 277 (45,79%) epilepsias sintomáticas, 156 (25,79%) idiopáticas y 172 (28,43%) criptogénicas. La epilepsia de ausencias y la epilepsia benigna de la infancia con paroxismos centrotemporales son los síndromes epilépticos idiopáticos con mayor prevalencia, y las encefalopatías prenatales las epilepsias sintomáticas más prevalentes. El 26,12% iniciaron su epilepsia el primer a˜no, siendo sintomáticas el 67,72%. Se han considerado refractarias el 25,29% de las epilepsias; el 42,46% asocia déficit cognitivo, el 26,45% afectación motora y el 9,92% trastorno del espectro autista, siendo más frecuentes a menor edad de inicio. CONCLUSIONES: La ausencia de una clasificación universalmente aceptada de los síndromes epilépticos dificulta trabajos como este, empezando por la terminología. Una clasificación útil es la etiológica, con 2 grupos: un gran grupo con las etiologías establecidas o síndromes genéticos muy probables, y otro de casos sin causa establecida. La edad de inicio de la epilepsia en cada grupo etiológico añade orientación pronóstica. El pronóstico de la epilepsia lo ensombrecen la refractariedad y las alteraciones asociadas del neurodesarrollo, siendo peor en general a más precoz inicio y en etiologías concretas

OBJECTIVE: A study of epilepsy, according to the age at onset of the crisis and its causes, monitored by a Paediatric Neurology Unit over a period of three years. PATIENTS AND METHODS: Historical cohorts study was conducted by reviewing the Paediatric Neurology medical records data base of epileptic children followed-up from 1 January 2008 to 31 December 2010. RESULTS: A total of 4,595 children were attended during the study period. The diagnosis of epilepsy was established in 605 (13.17%): 277 (45.79%) symptomatic, 156 (25.79%) idiopathic, and 172 (28.43%) with cryptogenic epilepsy. Absence epilepsy and benign childhood epilepsy with centro-temporal spikes are the idiopathic epileptic syndromes most prevalent, and the most prevalent symptomatic epilepsies are prenatal encephalopathies. More than one-quarter (26.12%) of epilepsies began in the first year of life, and 67.72% were symptomatic. Refractory epilepsy was observed in 25.29%, 42.46% with cognitive impairment, 26.45% with motor involvement, and 9.92% with an autism spectrum disorder, being more frequent at an earlier age of onset. CONCLUSIONS: The absence of a universally accepted classification of epileptic syndromes makes tasks like this difficult, starting with the terminology. A useful classification would be aetiological, with two groups: a large group with established aetiology, or very likely genetic syndromes, and another with no established cause. The age of onset of epilepsy in each aetiological group helps in the prognosis, which is worsened by refractoriness and associated neurodevelopmental disorders, and are generally worse at an earlier onset and in certain aetiologies

[A study of epilepsy according to the age at onset and monitored for 3 years in a regional reference paediatric neurology unit]. / Estudio de las epilepsias según la edad de inicio, controladas durante 3 años en una unidad de neuropediatría de referencia regional.

OBJECTIVE: A study of epilepsy, according to the age at onset of the crisis and its causes, monitored by a Paediatric Neurology Unit over a period of three years. PATIENTS AND METHODS: Historical cohorts study was conducted by reviewing the Paediatric Neurology medical records data base of epileptic children followed-up from 1 January 2008 to 31 December 2010. RESULTS: A total of 4,595 children were attended during the study period. The diagnosis of epilepsy was established in 605 (13.17%): 277 (45.79%) symptomatic, 156 (25.79%) idiopathic, and 172 (28.43%) with cryptogenic epilepsy. Absence epilepsy and benign childhood epilepsy with centro-temporal spikes are the idiopathic epileptic syndromes most prevalent, and the most prevalent symptomatic epilepsies are prenatal encephalopathies. More than one-quarter (26.12%) of epilepsies began in the first year of life, and 67.72% were symptomatic. Refractory epilepsy was observed in 25.29%, 42.46% with cognitive impairment, 26.45% with motor involvement, and 9.92% with an autism spectrum disorder, being more frequent at an earlier age of onset. CONCLUSIONS: The absence of a universally accepted classification of epileptic syndromes makes tasks like this difficult, starting with the terminology. A useful classification would be aetiological, with two groups: a large group with established aetiology, or very likely genetic syndromes, and another with no established cause. The age of onset of epilepsy in each aetiological group helps in the prognosis, which is worsened by refractoriness and associated neurodevelopmental disorders, and are generally worse at an earlier onset and in certain aetiologies.

Deceleration area and fetal acidemia.

AIMS: To compare the predictive ability for neonatal acidemia of individual components of intrapartum cardiotocography (CTG) described by National Institute of Child Health and Human Development (NICHD) system and deceleration area. DESIGN: Case-control study. SETTING: Spanish tertiary obstetrical hospital. POPULATION: CTG patterns of 102 acidemic fetus (umbilical arterial cord gas pH ≤7.10, base deficit (BD) > 8) and 102 nonacidemic controls (umbilical arterial cord gas pH > 7.10). METHODS: Two reviewers blind to clinical and outcome data analyzed the last thirty minutes before delivery of 204 fetal heart rate (FHR) tracings, extracting those features defined by NICHD and certain measures of FHR decelerations, including deceleration area, not considered by this system. OUTCOME MEASURES: The primary outcome was the predictive ability of NICHD features and non-NICHD deceleration measures for fetal acidemia. The secondary outcome was the impact of deceleration area in the last 30 min of labor on gasometry components (pH, BD and lactate). RESULTS: Minimal variability (area under the curve (AUC) 0.74), total number of late (AUC: 0.75) and prolonged decelerations (0.77) were the three NICHD features with the greatest predictive ability for fetal acidemia in the last thirty minutes of labor. Total deceleration area demonstrated the highest discrimination power (AUC: 0.83) of all the analyzed elements. For each cm2 the area increases in the last 30 min of labor, pH decreases 0.08 units, BD increases 0.272 mEq/L and lactate 0.183 mEq/L. CONCLUSIONS: Total deceleration area showed the greatest predictive ability for fetal acidemia and its measure could help to estimate intrapartum fetal acid-base status.

Fundamentos de antisepsia, desinfección y esterilización / Principles of antisepsis, disinfection and sterilization

Este artículo pretende realizar una breve revisión de los principales conceptos en los que se basan las medidas de prevención y control de la infección. La antisepsia comprende el conjunto de técnicas destinadas a la eliminación total (esterilización) o mayoritaria (desinfección) de los gérmenes que contaminan un medio. Ambos procedimientos deben ir precedidos de una limpieza del medio donde se vayan a aplicar. La desinfección se lleva a cabo por medio de biocidas o germicidas, sustancias químicas antimicrobianas cuyos mecanismos de acción y resistencia son muy similares a los de los antibióticos. Esta similitud está generando inquietud por la posibilidad de cruce de información genética que agrave el problema de las resistencias bacterianas. La mayoría de los biocidas pueden actuar como antisépticos, aplicados sobre piel y tejidos, o desinfectantes, sobre materiales inanimados. El espectro de acción de los germicidas depende de las características propias del producto y de factores externos controlables: temperatura, concentración, tiempo de exposición, etc. Las técnicas de esterilización son fundamentalmente de carácter físico, a través de autoclaves que exponen el material a vapor o gas esterilizante. Los mayores avances están en las exposiciones a bajas temperaturas con tiempos más cortos de exposición, en paralelo con los avances tecnológicos de instrumentación con materiales que no soportan temperaturas elevadas y con rotaciones de uso altas, por la presión asistencial

This article aims to provide a brief review of the main concepts on which the prevention and control of infection are based. Antisepsis comprises a set of techniques aimed at the total sterilization, or at most, disinfection, removing germs that contaminate an environment. Both procedures must be preceded by an environmental cleanup in the location in which they intend to be applied. The disinfection is carried out using biocides or germicides. Antimicrobial chemicals, that have mechanisms of action and resistances very similar to antibiotics, are generating concern due to the possibility of crossing genetic information that aggravates the problem of bacterial resistance. Most biocides can act as antiseptics, and applied to skin tissue, or disinfectants on inanimate materials. The spectrum of action of germicides depends on the product itself and external controllable factors: temperature, concentration, exposure time, etc. Sterilization techniques are primarily physical, by exposing the material to steam, or sterilizing gas, using autoclaves. Major advances are the use of low temperatures with shorter exposure times, in parallel with technological advances in instrumentation in order to avoid high temperatures and high use rotations due to workload

[Principles of antisepsis, disinfection and sterilization]. / Fundamentos de antisepsia, desinfección y esterilización.

This article aims to provide a brief review of the main concepts on which the prevention and control of infection are based. Antisepsis comprises a set of techniques aimed at the total sterilization, or at most, disinfection, removing germs that contaminate an environment. Both procedures must be preceded by an environmental cleanup in the location in which they intend to be applied. The disinfection is carried out using biocides or germicides. Antimicrobial chemicals, that have mechanisms of action and resistances very similar to antibiotics, are generating concern due to the possibility of crossing genetic information that aggravates the problem of bacterial resistance. Most biocides can act as antiseptics, and applied to skin tissue, or disinfectants on inanimate materials. The spectrum of action of germicides depends on the product itself and external controllable factors: temperature, concentration, exposure time, etc. Sterilization techniques are primarily physical, by exposing the material to steam, or sterilizing gas, using autoclaves. Major advances are the use of low temperatures with shorter exposure times, in parallel with technological advances in instrumentation in order to avoid high temperatures and high use rotations due to workload.

[Comparative study between pregnancies induced for premature rupture of membranes and for prolonged pregnancy]. / Estudio comparativo entre gestaciones finalizadas electivamente por rotura prematura de membranas y por gestación cronológicamente prolongada.

BACKGROUND: To decrease maternal and fetal morbidity oftem is indicated the elective termination of pregnancy; when the cervix is unfavourable, it is possible to try to artificially reproduce these changes with exogenous prostaglandins. OBJECTIVES: Comparative evaluation of maternal and fetal results between patients in which cervical ripening is practiced with indication of premature rupture of membranes and those with prolonged pregnancy. MATERIAL AND METHOD: Historic cohorts study about pregnancies requiring cervical ripening, either for premature rupture of membranes or for gestational age > or = 41 weeks, in the "Miguel Servet" Hospital (Zaragoza, Spain), from 15/11/2005 to 15/05/2008. In all the cases dinoprostone (slow release vaginal system) was employed and the initial Bishop score was < 7. The main analysed outcomes were: intrapartum fetal heart monitoring characteristics, type of delivery, umbilical artery pH, Apgar score, hospitalization in neonatal unit requirement and time from cervical ripening start to delivery. RESULTS: Neonatal hospitalization was significantly more frequent in the ruptured membranes cohort (11.70% vs 2.33%); p = 0.001. This difference could be justified by gestational age (OR: 2,623. IC: 0.515-13.353. P = 0.246). It was observed more time cervical ripening - delivery in prolonged pregnancies cohort (25.96h vs 20.11h); p < 0.001. Umbilical cord medium pH was significantly superior in ruptured membranes group (7.25 vs 7.23); p = 0.017. No significant differences were observed in the rest of analyzed outcomes. CONCLUSIONS: Pregnancies electively ended for premature rupture of membranes are associated with a shorter time to delivery and a slightly superior umbilical cord pH than induced prolonged pregnancies. Neonatal hospitalization requirement is determined by gestational age but not by the rupture of the membranes. Cervical ripening in those patients has been demonstrated to be secure and effective.

Complicaciones perinatales de la hiperdatia gestacional / Perinatal complications of post-term pregnancy

Objetivo. El propósito de este estudio es evaluar la morbilidad y mortalidad perinatales asociadas a las gestaciones que finalizan en la semana 41. Sujetos y métodos. Se ha diseñado un estudio de cohortes históricas. Los resultados perinatales de 230 gestaciones de 41 semanas se compararon con 234 gestaciones que finalizaron entre las 37 y las 40 semanas de gestación en el Hospital Universitario Miguel Servet en 2005. Resultados. Las tasas de oligoamnios, líquido amniótico teñido, macrosomía, puntuación en el test de Apgar a los 5minutos < 7 y valores bajos de pH arterial umbilical aumentan a las 41 semanas de gestación respecto a los embarazos entre las 37 y 40 semanas de gestación (significación estadística p<0,05). Conclusiones. Se ha encontrado que la tasa de complicaciones perinatales se incrementa cuando se alcanza la semana 41 de gestación. La apropiada investigación de este hecho es importante en la determinación de la edad gestacional a la cual el riesgo de continuar el embarazo supera el riesgo de una inducción de parto(AU)

Objective. The aim of this study was to evaluate the perinatal morbidity and mortality associated with pregnancies ending at 41 weeks. Subjects and methods. We designed a retrospective cohort study. The perinatal outcomes of 230 pregnancies ending at 41 weeks’ gestation were compared with those of 234 pregnancies ending at between 37 and 40 weeks’ gestation at the Miguel Servet University Hospital in 2005. Results. The rates of oligohydramnios, meconium-stained amniotic fluid, macrosomia, 5-minute Apgar score < 7 and low umbilical artery pH were all increased at 41 weeks’ gestation compared with pregnancies ending at between 37 and 40 weeks’ gestation (P<.05). Conclusions. We found that the rates of perinatal complications increased as pregnancy was prolonged to 41 weeks. Accurate investigation of these rates is important to determine the gestational age at which the risk of continuing the pregnancy outweighs the risk of labor induction(AU)

Recomendaciones para la prevención de la neumonía asociada a ventilación mecánica / Recommendations for the prevention of mechanical ventilation-associated pneumonia

No disponible

No disponible

[Efficiency and cost-effectiveness for a safety device]. / Efectividad y coste-efectividad de un dispositivo de seguridad.

When dealing with preventive measures, it is necessary to evaluate their effectiveness and to analyze the costs involved in implementing those measures. Therefore, the authors carried out a before-after intervention study on the use of a safe intravenous peripheral catheter in emergency ward services; this study included the participation by workers in selecting material by means of a Likert questionnaire. The effectiveness of a safe intravenous peripheral catheter was calculated comparing skin accidents caused by this device 40 months before and after its implantation. An economic analysis was calculated by means of a cost-effectiveness index fined as a "Euros spent for accident prevented" index. Workers who participated chose a passive safe intravenous peripheral catheter (p < 0.05). During the pre-intervention period, 17 intravenous peripheral catheter expositions were declared, during the post-intervention period, none were declared. The total net cost per intervention came to 36.606 Euro. The cost effectiveness index was 2.579,3 Euro for accident prevented.

Efectividad y coste-efectividad de un dispositivo de seguridad / Efficiency and Cost-Effectiveness for a safety device

En actividades de prevención es necesario evaluar la efectividad y analizar el coste de su implantación. Por ello, se efectúa un estudio de intervención antes-después del uso de un catéter endovenoso periférico (CEVP) seguro, en un Servicio de Urgencias, con participación de trabajadores en la selección del material con una encuesta tipo Likert. La efectividad del CEVP seguro se midió comparando accidentes percutáneos por el dispositivo 40 meses antes y después de la introducción del mismo. El análisis económico se calculó mediante un índice coste-efectividad definido como «euros gastados por accidente evitado». Los trabajadores eligieron un CEVP de seguridad pasiva (p < 0,05). En periodo preintervención se declararon 17 exposiciones por CEVP, en periodo postintervención no se declaró ninguna. El coste total neto de la intervención supuso 36.606 €. El índice coste-efectividad fue de 2.579,3 € por accidente evitado(AU)

When dealing with preventive measures, it is necessary to evaluate their effectiveness and to analyze the costs involved in implementing those measures. Therefore, the authors carried out a before-after intervention study on the use of a safe intravenous peripheral catheter in emergency ward services; this study included the participation by workers in selecting material by means of a Likert questionnaire. The effectiveness of a safe intravenous peripheral catheter was calculated comparing skin accidents caused by this device 40 months before and after its implantation. An economic analysis was calculated by means of a cots-effectiveness index fined as a «Euros spent for accident prevented» index. Workers who participated chose a passive safe intravenous peripheral catheter (p < 0,05). During the pre-intervention period, 17 intravenous peripheral catheter expositions were declared; during the post-intervention period, none were declared. The total net cost per intervention came to € 36.606. The cost effectiveness index was € 2.579,3 for accident prevented(AU)

[Cervical preinduction and oligoamnios]. / Preinducción cervical y oligoamnios.

BACKGROUND: Twelve percent of women with 41 weeks of gestation and more had oligoamnios. Physiopathological mechanism of this disease still is under discussion. OBJECTIVE: To evaluate perinatal result of patients with more than 41 weeks of gestation oligoamnios-preinduced. PATIENTS AND METHOD: Analytic-observational and retrospective cohorts study. Patients with more than 41 weeks of gestation, oligoamnios-preinduced, were included. All patients received dinoprostone and had a Bishop score lower than seven. Amniotic fluid index of five or lower suggests diagnosis of oligoamnios. Preinduction indication, characteristics of intrapartum fetal monitoring, umbilical artery pH, Apgar score, neonatal weight, and admission in a neonatal unit were the variables analyzed. RESULTS: Among the 96 patients, 28 (29.2%) constituted the exposed cohort and 68 (70.8%) the non-exposed one. Both groups were homogeneous in maternal age, parity and initial Bishop score. There weren't significant differences for way of delivery, cesarean section indications, meconium-stained amniotic fluid and umbilical cord pathology. Frequency of bradycardia was significantly higher in oligoamnios group (14.3 vs 1.5%), as well as Apgar score at first (mean of 8.86 vs 8.38) and fifth birth minute (mean of 9.89 vs 9.69). Fetal weight was significantly lower (3,298 vs 3,546 g) in oligoamnios group. Admission in neonatal unit was higher in the non-exposed cohort (1.47%). CONCLUSIONS: Newborns of patients with oligoamnios had a better Apgar score, lower fetal weight and higher frequency of intrapartum bradycardia (without neonatal damage). A further study may offer new conclusions.

[Predictive model for nosocomial pneumonia in intensive care units]. / Modelo predictivo de neumonía nosocomial en unidades de cuidados intensivos.

BACKGROUND AND OBJECTIVE: Nosocomial pneumonia is the most common nosocomial infection in the intensive care units (ICUs) and contributes disproportionately to both poor outcomes and high cost of care in critically ill patients. In order to identify patients with greater risk of developing nosocomial pneumonia in ICUs, it is important to select the right preventive measures. PATIENTS AND METHOD: It was an observational study of 2 prospective cohorts of patients staying in the ICU for 24 h or more: the main cohort (n=1,184) and the validation cohort (n=554). A predictive model was constructed with the data of the main cohort using a logistic regression. Receiver operating characteristic (ROC) curves and predictive values for different cut points were obtained with the data of both cohorts. RESULTS: Eight variables were selected for the predictive model: parenteral nutrition, enteral nutrition, nasogastric intubation, tracheostomy, mechanical ventilation, previous surgery, coma and diabetes. In the main cohort, the model had a sensitivity of 81% and a specificity of 78.4% in predicting nosocomial pneumonia (Hosmer-Lemeshow statistic p=0.93; area under ROC curve=0.861; 95% confidence interval, 0.824-0.898). In the validation cohort, the area under ROC curve was 0.849 (95% confidence interval, 0.742-0.956). CONCLUSIONS: The resulting model presents satisfactory results in both cohorts. In addition, the variables used are simple, routinely available, and familiar to clinicians.

Modelo predictivo de neumonía nosocomial en unidades de cuidados intensivos / Predictive model for nosocomial pneumonia in intensive care units

Fundamento y objetivo: La neumonía es la infección nosocomial más frecuente en unidades de cuidados intensivos (UCI) y contribuye enormemente tanto a desenlaces negativos como a elevados costes en pacientes críticos. Identificar a los pacientes con mayor riesgo de desarrollar una neumonía nosocomial es importante para seleccionar medidas preventivas correctas. Pacientes y método: Se ha realizado un estudio observacional y prospectivo de 2 cohortes de pacientes ingresados en UCI durante 24 h o más: la cohorte principal (n = 1.184) y la cohorte de validación (n = 554). Se construyó un modelo predictivo con los datos de la cohorte principal mediante regresión logística. Se obtuvieron curvas de eficacia diagnóstica y valores predictivos para diferentes puntos de corte con los datos de ambas cohortes. Resultados: Para el modelo predictivo se eligieron 8 variables: nutrición parenteral, nutrición enteral, intubación nasogástrica, traqueostomía, ventilación mecánica, cirugía previa, coma y diabetes. En la cohorte principal el modelo tuvo una sensibilidad del 81% y una especificidad del 78,4% en la predicción de neumonía nosocomial (test estadístico de Hosmer-Lemeshow, p = 0,93; área bajo la curva de eficacia diagnóstica = 0,861; intervalo de confianza del 95%, 0,824-0,898). En la cohorte de validación el área bajo la curva de eficacia diagnóstica fue de 0,849 (intervalo de confianza del 95%, 0,742-0,956). Conclusiones: El modelo obtenido presenta unos resultados satisfactorios en ambas cohortes. Además, las variables usadas son simples, disponibles en la práctica habitual y familiares para los clínicos

Background and objective: Nosocomial pneumonia is the most common nosocomial infection in the intensive care units (ICUs) and contributes disproportionately to both poor outcomes and high cost of care in critically ill patients. In order to identify patients with greater risk of developing nosocomial pneumonia in ICUs, it is important to select the right preventive measures. Patients and method: It was an observational study of 2 prospective cohorts of patients staying in the ICU for 24 h or more: the main cohort (n = 1,184) and the validation cohort (n = 554). A predictive model was constructed with the data of the main cohort using a logistic regression. Receiver operating characteristic (ROC) curves and predictive values for different cut points were obtained with the data of both cohorts. Results: Eight variables were selected for the predictive model: parenteral nutrition, enteral nutrition, nasogastric intubation, tracheostomy, mechanical ventilation, previous surgery, coma and diabetes. In the main cohort, the model had a sensitivity of 81% and a specificity of 78.4% in predicting nosocomial pneumonia (Hosmer-Lemeshow statistic p = 0.93; area under ROC curve = 0.861; 95% confidence interval, 0.824-0.898). In the validation cohort, the area under ROC curve was 0.849 (95% confidence interval, 0.742-0.956). Conclusions: The resulting model presents satisfactory results in both cohorts. In addition, the variables used are simple, routinely available, and familiar to clinicians

[Flu vaccination in healthcare workers]. / Vacunación antigripal en personal sanitario.

BACKGROUND AND OBJECTIVE: The aim of this study was to determine the trends in yearly vaccination coverage in healthcare workers. METHOD: Cross-sectional epidemiological study over fifteen seasons (1990-2005). Overall vaccination coverage and coverage by professional category was estimated annually. The chi-square test and Mantel-Haenszel test for linear trend were used for the statistical analysis. RESULTS: The greatest vaccination coverage was in the 2003-04 season (15.9%; 95% CI: 14.8-17) and the 2005-06 season (16.3%; 95% CI: 15.3-17.4). The medical staff and residents showed the highest coverage (30.1%). A positive trend was observed along the period. CONCLUSIONS: An increasing trend in influenza vaccination coverage has been observed in healthcare workers.