[Impact of the "daily huddle" on the safety of pediatric hospitalized patients]. / Impacto de los «daily huddle¼ en la seguridad del paciente pediátrico hospitalizado.

INTRODUCTION: In 2017, the Joint Commission proposed daily meetings called "huddle" as an indicator of quality of care. They are brief daily meetings of the multidisciplinary team, where security problems of the last 24h are shared and risks are anticipated. The objectives were to describe the most frequent safety events in Pediatric wards, implement improvements in patient safety, improve team communication, implement international safety protocols, and measure the satisfaction of the staff involved. MATERIAL AND METHODS: Prospective, longitudinal and analytical design (June 2020-February 2022), with previous educational intervention. Safety incidents, data related to unequivocal identification, allergy and pain records, data from the Scale for the Early Detection of Deficiencies (SAPI) and the Scale for the Secure Transmission of Information (SBAR) were collected. The degree of satisfaction of the professionals was evaluated. RESULTS: Three hundred forty-eight security incidents were recorded. Medication prescription or administration errors stood out (n=103). Drug prescription or administration errors stood out (n=103), especially those related to high-risk medication: acetaminophen (n=14) (×10 doses of acetaminophen; n=6), insulin (n=6), potassium (n=5) and morphic (n=5). An improvement was observed in the pain record; 5% versus 80% (P<.01), in the SAPI registry 5% versus 70% (P<.01), in SBAER scale 40% vs 100% (P<.01), in unequivocal identification of the patient 80% versus 100%; (P<.01) and in the application of analgesic techniques 60% versus 85% (P=.01). In the survey of professionals, a degree of satisfaction of 8 (7-9.5)/10 was obtained. CONCLUSIONS: Huddles made it possible to learn about security events in our environment and increase the safety of hospitalized patients, and improved communication and the relationship of the multidisciplinary team.

Impact of an influenza vaccine educational programme on healthcare personnel.

Influenza vaccination has been shown to be the most effective preventive strategy to reduce influenza-related morbidity and mortality in high-risk groups. Despite healthcare personnel (HCP) being considered part of such high-risk groups, their vaccination coverage is low in Europe. In January 2012, we distributed an 18-question survey regarding influenza vaccination to HCP at Gregorio Marañon Paediatric Hospital, in Madrid, Spain. After we documented that only ~30% of HCP were vaccinated an educational programme was implemented in October 2012 before the next influenza season. In January 2013, the same survey delivered again to all HCP documented a significant increase in vaccination rates (from 30% to 40%, P = 0·007) mainly among physicians and for patients' protection. In summary we found that a simple and inexpensive educational programme significantly improved the uptake of influenza vaccination in HCP in our centre. Nevertheless, vaccination rates remained low, and broader and updated campaigns are needed to overcome perception barriers.

In situ detection of salicylate in Ocimum basilicum plant leaves via reverse iontophoresis.

The quantitative analysis of salicylate provides useful information for the evaluation of metabolic processes in plants. We report a simple, noninvasive method to measure salicylate in situ in Ocimum basilicum leaves using reverse iontophoresis in combination with cyclic voltammetry at disposable screen-printed electrodes and the concentration of salicylate in basil leaves was found to be 3 mM.

Impacto clínico de la implantación de la ventilación por alto flujo de oxígeno en el tratamiento de la bronquiolitis en una planta de hospitalización pediátrica / Clinical impact of introducing ventilation with high flow oxygen in the treatment of bronchiolitis in a paediatric ward

Objetivo: Analizar la eficacia y la seguridad del sistema de alto flujo de oxígeno de aire caliente y humidificado para el tratamiento de la bronquiolitis aguda moderada-grave en las plantas de hospitalización de un hospital terciario. Métodos: Estudio prospectivo observacional de los pacientes diagnosticados de bronquiolitis ingresados en planta en un hospital terciario que fueron tratados con ventilación con alto flujo (sistema Fisher & Paykel®). Se evaluaron horariamente los parámetros clínicos y cardiorrespiratorios durante el tratamiento. Resultados: Se incluyó a 25 pacientes, con una mediana de 2 meses (rango 0,6-11 meses). El 75% de ellos fueron VRS positivos. Las indicaciones del alto flujo fueron: progresión de la dificultad respiratoria (Wood-Downes ≥ 8) (88%), pausas de apnea (8%) y desaturación (4%). La mediana de días de tratamiento fue de 4 días (rango 3-7 días), con una mediana de 9 días totales de ingreso (rango 8-12 días). El alto flujo produjo una disminución significativa de los parámetros cardiorrespiratorios frecuencia cardiaca, frecuencia respiratoria, produciendo una mejoría significativa de la escala de Wood-Downes (desde 10 ± 1,21 hasta 3 ± 0,77; p = 0,001). No se observaron efectos adversos. Precisaron ingreso en la unidad de cuidados intensivos (UCIP) 5 pacientes (20%), por lo que se evitaron un 80% de los ingresos en la UCIP con este método. Conclusiones: La ventilación con alto flujo consigue una mejoría significativa de frecuencia cardiaca, frecuencia respiratoria y de la escala de gravedad en los pacientes con bronquiolitis. Permite un tratamiento de estos pacientes en planta de hospitalización, sin asociar efectos adversos, reduciendo los ingresos en la UCIP(AU)

Objective: To analyse the safety and efficacy of high-flow oxygen therapy for treatment of moderate to severe bronchiolitis in children admitted to the paediatric hospital wards. Methods: A prospective observational study was conducted on children < 18 months of age with bronchiolitis admitted to the paediatric ward of a tertiary-care teaching hospital during the 2011-12 respiratory season. Children were treated with a high-flow ventilation system (Fisher & Paykel). Clinical and cardio-respiratory parameters were evaluated every hour for the duration of therapy. Results: A total of 25 patients, with a median age of 2 months (range: 0.6-11 months) were included. Respiratory syncytial virus (RSV) was positive in 75% of cases. Indications for high-flow therapy included: progressive respiratory distress (Wood-Downes ≥ 8) (88%), apnoea (8%) and desaturation (4%). Median duration of therapy was 4 days (range: 3-7 days), with a median of 9 days in hospital (range: 8-12 days). High flow therapy was associated with a significant decrease in cardio-respiratory parameters, heart rate, respiratory rate, which resulted in a significant improvement of the Wood-Downes Score (from 10±1.21 to 3±0.77, P=.001). No adverse effects were observed. Five patients (20%) were admitted to the Paediatric Intensive Care Unit (PICU), which represents an 80% reduction of PICU admissions compared with historic data of previous years. Conclusions: High-flow ventilation therapy achieved a significant improvement in heart rate, respiratory rate, and scale of severity in patients with bronchiolitis. This novel therapeutic strategy allows safe management of bronchiolitis patients in the regular ward, reducing admissions to the PICU(AU)

[Clinical impact of introducing ventilation with high flow oxygen in the treatment of bronchiolitis in a paediatric ward]. / Impacto clínico de la implantación de la ventilación por alto flujo de oxígeno en el tratamiento de la bronquiolitis en una planta de hospitalización pediátrica.

OBJECTIVE: To analyse the safety and efficacy of high-flow oxygen therapy for treatment of moderate to severe bronchiolitis in children admitted to the paediatric hospital wards. METHODS: A prospective observational study was conducted on children < 18 months of age with bronchiolitis admitted to the paediatric ward of a tertiary-care teaching hospital during the 2011-12 respiratory season. Children were treated with a high-flow ventilation system (Fisher & Paykel). Clinical and cardio-respiratory parameters were evaluated every hour for the duration of therapy. RESULTS: A total of 25 patients, with a median age of 2 months (range: 0.6-11 months) were included. Respiratory syncytial virus (RSV) was positive in 75% of cases. Indications for high-flow therapy included: progressive respiratory distress (Wood-Downes ≥ 8) (88%), apnoea (8%) and desaturation (4%). Median duration of therapy was 4 days (range: 3-7 days), with a median of 9 days in hospital (range: 8-12 days). High flow therapy was associated with a significant decrease in cardio-respiratory parameters, heart rate, respiratory rate, which resulted in a significant improvement of the Wood-Downes Score (from 10±1.21 to 3±0.77, P=.001). No adverse effects were observed. Five patients (20%) were admitted to the Paediatric Intensive Care Unit (PICU), which represents an 80% reduction of PICU admissions compared with historic data of previous years. CONCLUSIONS: High-flow ventilation therapy achieved a significant improvement in heart rate, respiratory rate, and scale of severity in patients with bronchiolitis. This novel therapeutic strategy allows safe management of bronchiolitis patients in the regular ward, reducing admissions to the PICU.

Electrochemical detection of extracellular hydrogen peroxide in Arabidopsis thaliana: a real-time marker of oxidative stress.

An electrochemical approach to directly measure the dynamic process of H2 O2 release from cultures of Arabidopsis thaliana cells is reported. This approach is based on H2 O2 oxidation on a Pt electrode in conjunction with continuous measurement of sample pH. For [H2 O2 ] <1 mm, calibration plots were linear and the amperometric response of the electrode was maximum at pH 6. At higher concentrations ([H2 O2 ] >1 mm), the amperometric response can be described by Michaelian-type kinetics and a mathematical expression relating current intensity and pH was obtained to quantitatively determine H2 O2 concentration. At pH 5.5, the detection limit of the sensor was 3.1 µm (S/N = 3), with a response sensitivity of 0.16 Am(-1 ) cm(-2) and reproducibility was within 6.1% in the range 1-5 × 10(-3 ) m (n = 5). Cell suspensions under normal physiological conditions had a pH between 5.5-5.7 and H2 O2 concentrations in the range 7.0-20.5 µm (n = 5). The addition of exogenous H2 O2 , as well as other potential stress stimuli, was made to the cells and the change in H2 O2 concentration was monitored. This real-time quantitative H2 O2 analysis is a potential marker for the evaluation of oxidative stress in plant cell cultures.

Fluorescence decrease of conjugated polymers by the catalytic activity of horseradish peroxidase and its application in phenolic compounds detection.

We report the fluorescence decrease of the water-soluble π-π-conjugated polymer poly(2-methoxy-5-propyloxy sulfonate phenylene vinylene, MPS-PPV) by the catalytic activity of horseradish peroxidase in the presence of H(2)O(2). MPS-PPV acts as a donor substrate in the catalytic cycle of horseradish peroxidase where the electron-deficient enzymatic intermediates compounds I and II can subtract electrons from the polymer leading to its fluorescence decrease. The addition of phenolic drug acetaminophen to the former solution favors the decrease of the polymer fluorescence, which indicates the peroxidase-catalyzed co-oxidation of MPS-PPV and acetaminophen. The encapsulation of horseradish peroxidase within polyacrylamide microgels allows the isolation of intermediates compound I and compound II from the polymer, leading to a fluorescence decrease that is only due to the product of biocatalytic acetaminophen oxidation. This system could be used to develop a new device for phenolic compounds detection.

Development of an acetaminophen amperometric biosensor based on peroxidase entrapped in polyacrylamide microgels.

In this work, horseradish peroxidase (HRP) has been entrapped in cross-linked polyacrylamide microparticles using the concentrated emulsion polymerization method. The feasibility of amperometric detection of acetaminophen (APAP) in a biosensor using this HRP immobilized system as the biological material in the presence of hydrogen peroxide was investigated. We found that the optimum microgel cross-linking degree required to retain the protein and to allow the diffusion of the phenolic drug onto the microparticles was 8%. The apparent diffusion coefficients of APAP across the different microparticles have been calculated using the Cottrell equation. The diffusion coefficients decrease as the microgel cross-linking increases, and the data fit an uniexponential equation well. Those microparticles with a cross-linking degree lower than 5% operated under kinetic control, whereas those whose cross-linking degree was above this value operated under diffusion control. Biosensor response was also optimized to investigate the effect of H(2)O(2) concentration and enzyme loading on the current intensity. Under optimal conditions, the sensitivity of this biosensor for APAP was 74.9 mA M(-1) cm(-2), the detection limit was 3.1×10(-6) M based on S/N=3 and the response time was 135 s. The linear range goes from 1.0×10(-5) to 4.9×10(-4) M APAP, and can be extended using the Hill equation to 5.7×10(-3) M. The biosensor is selective for APAP and was applied to determine the APAP concentration in three commercial pharmaceutical formulations.

[Coinfection with chlamydia and mycoplasma. Incidence in our environment]. / Coinfección por Chlamydia y Mycoplasma. Incidencia en nuestro medio.

OBJECTIVES: To investigate the presence Mycoplasma pneumoniae and Chlamydia pneumoniae and to determine their importance as the cause of community-acquired pneumonia in childhood. MATERIAL AND METHODS: We performed a retrospective descriptive study of all the patients aged less than 15 years old diagnosed with community-acquired pneumonia due to M. pneumoniae in the pediatric emergency department of our hospital between May 1998 and May 2000. Patients in whom C. pneumoniae was also identified as a cause of pneumonia were investigated. RESULTS: Of 242 cases of community-acquired pneumonia, 82 were due to M. pneumoniae (34.7 %) and 32 were due to C. pneumoniae (13.22 %) Of these, eight cases were coinfections with C. pneumoniae and M. pneumoniae. Most infections occurred in boys (5/8). The mean age at diagnosis was 7.7 years. No seasonal predominance was found. CONCLUSIONS: Both C. pneumoniae and M. pneumoniae play a substantial role in community-acquired pneumonia in children aged more than 5 years old. Although coinfection with both species usually worsens the course of the disease, outcome in all the patients studied was satisfactory.

Neumonía por "Mycoplasma pneunoniae" en pacientes menores de 3 años / " Micoplasma pneumoniae" pneumonia in patients under three years of age

Mycoplasma pneumoniae es una de las causas más frecuentes de neumonía en niños mayores de 5 años, pero es raramente descrita en niños menores de 3 años. Objetivos. Estudiar los casos de neumonía por Mycoplasma pneumoniae diagnosticados en nuestro hospital, en pacientes menores de 3 años. Material y métodos. Se revisaron todos los casos de neumonías diagnosticados en nuestro centro desde el 1 de mayo de 1995 al 31 de diciembre de 1998. Durante este tiempo fueron diagnosticados un total de 452 casos de neumonías ambulatorias en el servicio de urgencias de nuestro hospital, 129 de las cuales (30 por ciento) estaban causadas por Mycoplasma pneumoniae; en todas ellas se recogieron datos epidemiológicos, clínicos, bioquímicos y microbiológicos. Resultados. Durante estos 3 años de estudio documentamos un total de 129 neumonías por Mycoplasma, de las que 13 casos se presentaron en pacientes menores de 3 años de edad; de ellos, 5 no habían cumplido los 2 años, con un predominio del sexo masculino en 10 de los niños. Las manifestaciones clínicas más frecuentes fueron fiebre (12 casos), tos (11 casos), y buen estado general (6 casos). La auscultación pulmonar fue normal en 4 casos. La localización más frecuente de la condensación neumónica fue el lóbulo inferior del pulmón derecho. Los hallazgos analíticos no presentaron alteraciones significativas. El tratamiento antibioticoterápico consistió en macrólidos en 4 casos y betalactámicos en 9, y el resultado fue satisfactorio en los 13 casos estudiados. Se observaron manifestaciones extrapulmonares en 3 pacientes con exantemas. Conclusiones. Aunque Mycoplasma pneumoniae no es una causa frecuente de neumonía en paciente menores de 5 años, dicha etiología no debe ser despreciada en paciente menores de 3 años (AU)

Mancha mongólica / Mongolian spots

La mancha mongólica es una mácula pigmentada de color azul o grisáceo, fisiológica en el recién nacido, que se observa en más del 90 por ciento de la población negra y asiática, el 50 por ciento de la hispana y el 10 por ciento de la raza blanca. Las localizaciones más frecuentes son: región lumbosacra, glúteos, hombros y espal-da; otras localizaciones son más raras. Se presenta el caso de un varón de 7 meses de edad, con manchas mongólicas en tronco, espalda y extremidades, que en un principio fueron consideradas como sospechosas de malos tratos (AU)

Craneosinostosis: escafocefalia / Craniosynostosis involving the sagittal suture (scaphocephaly)

Craneosinostosis es el cierre prematuro de suturas craneales que, según la sutura afecta, puede corresponder a diferentes entidades clínicas, de las que la más frecuente es el cierre de la sutura sagital o escafocefalia. Presentamos a continuación el caso de un niño de 3 meses de edad diagnosticado de cierre precoz de sutura sagital (escafocefalia), con una importante deformidad estética, que tras estudio radiológico y tomográfico mediante tomografia axial computarizada (TAC) y helicoidal computarizada tridimensional (3D THC), fue sometido a tratamiento quirúrgico precoz. La tomografía tridimensional nos proporciona una idea más real de las deformaciones y nos aporta datos suficientes para una mejor elección de la técnica quirúrgica a utilizar (AU)

Adenitis cervical secundaria a infección por 'Streptococcus pyogenes' / Cervical adenitis secondary to "Streptococcus pyogenes" infection

La adenitis es una patología usual en pediatría y la localización cervical suele ser una de las más habituales. Su etiología es muy variada, desde procesos autolimitados hasta cuadros graves que ponen en peligro la vida del paciente. La causa más frecuente es la infecciosa, sobre todo la de origen vírico, seguido del bacteriano, principalmente adenitis secundarias a infecciones por Staphylococcus aureus, Streptococcus pyogenes y Mycobacterium sp. Se describe el caso de un niño de 4 años que es visto en el servicio de urgencias por un proceso febril de 4 días de evolución y que presenta una tumoración cervical de 6 X 6 cm. En su investigación etiológica aparece una faringitis estreptocócica (AU)

Quiste óseo esencial de pelvis / Pelvic bone cyst of unknown etiology

El quiste óseo esencial (QOE) es una lesión poco frecuente, que aparece fundamentalmente en adolescentes durante la segunda década de vida. Su localización más frecuente es la parte proximal del húmero y fémur, y es mucho más rara la afectación de la pelvis. Estos quistes suelen ser aislados y unicamerales. Es necesario efectuar un diagnóstico diferencial entre quistes óseos benignos y tumores óseos malignos, ya sea mediante estudio radiológico o biopsia de las lesiones. Presentamos el caso de un adolescente de 13 años con un quiste esencial de cadera (AU)

Exantema generalizado secundario a alergia a proteínas de leche de vaca / Generalized rash secondary to allergy to the proteins in cow's milk

La evaluación de las reacciones adversas a alimentos es uno de los retos más importantes en la práctica médica debido a la cuantía de sus diagnósticos diferenciales, la falta de procedimientos diagnósticos seguros y la ausencia de medidas profilácticas. A continuación describimos el caso de una lactante de mes y medio de edad, que acude a Urgencias por presentar, desde el día anterior, rechazo de algunas tomas, vómitos y erupción cutánea, inicialmente localizada en el cuello y extremidades inferiores, que aumenta y se extiende a todo el cuerpo, coincidiendo con la introducción de la lactancia mixta (AU)

Parálisis facial izquierda secundaria a otitis izquierda supurada en una niña de 4 meses / Left facial paralysis secondary to left suppurative otitis in a 4-month-old-girl

La parálisis facial es una complicación infrecuente de la otitis media en la infancia. Presentamos la historia de una lactante de 4 meses diagnosticada de otitis izquierda aguda y que 24 horas después de su diagnóstico e inicio del tratamiento con antibioticoterapia, padece parálisis facial ipsolateral, que cedió espontáneamente a los diez días una vez curado su proceso infeccioso (AU)

[Accidental contact with syringes used by intravenous drug users (IDU): a decade of study]. / Contactos accidentales con jeringas utilizadas en drogadicción (ADVP): una década de seguimiento.

OBJECTIVE: The increase in drug addiction, AIDS, hepatitis C and B transmission is a problem the society faces with growing frequency, mainly due to syringes and other material used by seropositive patients being left in public place, with children being one of the groups being at greatest risk. We present our experience in accidents with syringes used by intravenous drug users (IDU) in patients less than 16 years of age during the last 11 years. PATIENTS AND METHODS: All patients attending our emergency department with diagnosis of contact with syringes used by IDU were prospectively studied. All patients were treated according to the follow-up protocol of accidental contact with syringes used by IDU. RESULTS: We studied 183 patients between 0 and 16 years of age, with a male gender predominance, the average age at presentation was 6.7 years. The majority of cases occurred during the months of April through August. One hundred twenty-eight cases completed the control after 1 year. At the one year control after the accident, 99% of the patients were anti-HBs antibody positive. Other markers positive for HBV were found in 15% of the cases. Markers for HCV were found in only 9 of 84 patients studied. Only one patient that did not receive either the gamma globulin nor the vaccine developed hepatitis B infection. No patient showed HIV conversion during the time of the study. CONCLUSIONS: The risk of HIV and HCV after accidental puncture with syringes used by IDU is nearly none. Hepatitis B virus infection is the major risk. HBV transmission in the workplace can be largely eliminated due to the increased use of hepatitis B vaccine.