Destino de los artículos rechazados en Medicina Intensiva en el período 2015-2017 / Fate of rejected manuscripts in the journal Medicina Intensiva during 2015-2017 period

Objetivo Conocer el destino de los trabajos rechazados en Medicina Intensiva (MI) en el período del 2015 al 2017 con seguimiento hasta el 2019. Diseño Estudio retrospectivo observacional. Ámbito Publicaciones en revistas biomédicas. Participantes Manuscritos rechazados en la revista Medicina Intensiva. Intervenciones Ninguna Variables de interés Tiempo de publicación, factor de impacto (FI), citas generadas y variables asociadas con la publicación. Resultados De 344 originales y 263 cartas científicas, se rechazaron 420 (69,2%). Se publicaron después 205 (48,8%) y 66 de ellos generaron 180 citas. El FI de las revistas fue menor en 173 casos (84,4%). En 21, el número de citas válidas para FI fue mayor que el FI de MI. El origen del manuscrito odds ratio (OR) 2,11 (IC 95% 1,29 a 3,46), la mujer como autora OR 1,58 (IC 95% 1,03 a 2,44), que estuviera en lengua inglesa OR 2,38 (IC 95% 1,41 a 4,0) y que el artículo hubiera pasado a revisores OR 1,71 (IC 95% 1,10 a 2,66) se asociaron con mayor tasa de publicación en revistas indexadas en PubMed. Conclusiones Los artículos rechazados en MI tienen una tasa media de publicación en otras revistas, principalmente con menos FI y generando menor número de citas que el FI de MI. (AU)

Objective To know the fate of the rejected manuscripts in Medicina Intensiva journal (MI) from 2015 to 2017 with surveillance until 2019. Design Retrospective observational study. Setting Biomedical journals publication. Participants Rejected manuscripts in MI journal. Interventions None. Main variables of interest Time of publication, impact factor (IF), generated citations and variables associated to publication. Results The 69% (420) of analyzed articles (344 originals and 263 scientific letters) were rejected, and 205 (48.8%) were subsequently published, with 180 citations of 66 articles. Journal IF was lower in 173 (84.4%) articles. The number of FI-valid citations was higher than the FI of MI in 21 articles. Origin of manuscript OR 2,11 (IC 95% 1.29 – 3.46), female author OR 1.58 (IC 95% 1.03-2.44), english language OR 2,38 (IC 95% 1.41-4.0) and reviewed papers OR 1.71 (IC 95% 1.10-2.66) were associated to publication in PubMed database. Conclusions The rejected articles in MI have a mean publication rate in other journals. Most of these articles are published in journals with less IF and fewer citations than the IF of MI. (AU)

Fate of rejected manuscripts in the journal Medicina Intensiva during 2015-2017 period.

OBJECTIVE: To know the fate of the rejected manuscripts in Medicina Intensiva journal (MI) from 2015 to 2017 with surveillance until 2019. DESIGN: Retrospective observational study. SETTING: Biomedical journals publication. PARTICIPANTS: Rejected manuscripts in MI journal. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Time of publication, impact factor (IF), generated citations and variables associated to publication. RESULTS: The 69% (420) of analyzed articles (344 originals and 263 scientific letters) were rejected, and 205 (48.8%) were subsequently published, with 180 citations of 66 articles. Journal IF was lower in 173 (84.4%) articles. The number of FI-valid citations was higher than the FI of MI in 21 articles. Origin of manuscript OR 2,11 (IC 95% 1.29-3.46), female author OR 1.58 (IC 95% 1.03-2.44), english language OR 2,38 (IC 95% 1.41-4.0) and reviewed papers OR 1.71 (IC 95% 1.10-2.66) were associated to publication in PubMed database. CONCLUSIONS: The rejected articles in MI have a mean publication rate in other journals. Most of these articles are published in journals with less IF and fewer citations than the IF of MI.

Fate of rejected manuscripts in the journal Medicina Intensiva during 2015-2017 period. / Destino de los artículos rechazados en Medicina Intensiva en el período 2015-2017.

OBJECTIVE: To know the fate of the rejected manuscripts in Medicina Intensiva journal (MI) from 2015 to 2017 with surveillance until 2019. DESIGN: Retrospective observational study. SETTING: Biomedical journals publication. PARTICIPANTS: Rejected manuscripts in MI journal. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Time of publication, impact factor (IF), generated citations and variables associated to publication. RESULTS: The 69% (420) of analyzed articles (344 originals and 263 scientific letters) were rejected, and 205 (48.8%) were subsequently published, with 180 citations of 66 articles. Journal IF was lower in 173 (84.4%) articles. The number of FI-valid citations was higher than the FI of MI in 21 articles. Origin of manuscript OR 2,11 (IC 95% 1.29 - 3.46), female author OR 1.58 (IC 95% 1.03-2.44), english language OR 2,38 (IC 95% 1.41-4.0) and reviewed papers OR 1.71 (IC 95% 1.10-2.66) were associated to publication in PubMed database. CONCLUSIONS: The rejected articles in MI have a mean publication rate in other journals. Most of these articles are published in journals with less IF and fewer citations than the IF of MI.

Ocular Emergencies in Children: Demographics, Origin, Symptoms, and Most Frequent Diagnoses.

PURPOSE: To describe the epidemiology of ocular emergencies in children in a hospital-based emergency room (ER). METHODS: The medical reports of all children, 14 years of age and younger, who attended La Paz University Hospital (Madrid, Spain) ER from September 2015 to August 2016 were prospectively collected. Demographic data, origin, symptom for consultation, diagnostic tests, final diagnosis, and final referral of patients were recorded. RESULTS: A total of 774 children were attended: 57% boys and 43% girls. Mean age was 5 years (SD 4.10 years, range 0-14 years) without significant differences between sexes. Most children went to the ER because parents or teachers took the decision (75%), 24% were referred from the paediatric ER for evaluation, and 0.78% were referred from another hospital or by an out-clinic ophthalmologist. The reasons for consultation were red eyes (61%), traumatism (17%), referred from the paediatrician to have the fundus explored in children with headache (7%), eyelids problems (7%), and visual loss (7%). The most frequent diagnoses were infectious conjunctivitis (29%), corneal erosion (17%), normal examination (15%), and allergic conjunctivitis (13%). The most severe cases (visual loss, acute strabismus, and leucocoria) were referred by the paediatricians and represented 4.65% of the total patients. Visits occurred more frequently during the third trimester of the year (July-September), with a higher incidence of eye trauma in summer. CONCLUSIONS: Infectious conjunctivitis was the most frequent pathology. It is necessary to increase public awareness about the symptoms, the way of transmission, and treatment. Ocular trauma was also a common cause of presentation and the majority were contusional and mild. There is also a need for education of parents, teachers, and coaches regarding the potential for eye injuries. Ophthalmologists and paediatricians must take an active role in educating people about the prophylactic measures to prevent eye injuries in children.

Macular ganglion cell complex thinning in children with visual field defects due to central nervous system pathology.

PURPOSE: To study the relationship between macular ganglion cell complex (GCC) thickness and visual field defects (VFD) caused by central nervous system (CNS) lesions in children and evaluate the possibility of predicting VFD according to GCC maps. METHODS: The GCC maps of a group of children with VFD due to CNS lesions with respect of the vertical meridian in at least one eye (study group), as well as of children with other neuro-ophthalmological problems and healthy children were presented to two masked evaluators, who were asked to predict the patients' VFD on the basis of GCC damage: the evaluators classified VFD as normal, hemianopia (homonymous or heteronymous) or diffuse. RESULTS: Seventeen patients were included in the study group, with a median age of 12 years. Fifteen had brain tumours and two epilepsy. The mean MD of the affected hemifields was -26.00 dB (SD 7.89 dB) versus -5.51 dB (SD 3.52 dB) for the nonaffected hemifields, p < 0.001. The mean GCC thickness was of 56.04 µm (SD 11.95 µm) in the affected hemiretinas versus 74.31 µm (SD 10.64 µm) for the non-affected, p < 0.001. Kappa coefficients between VFD and those estimated by the evaluators were 0.705 and 0.658 (p < 0.001) for evaluators 1 and 2. CONCLUSIONS: GCC thickness can reflect damage to the visual pathway and GCC maps may be useful to identify chiasmal and retrochiasmal lesions, since GCC atrophy in most of these cases respects the vertical meridian. GCC maps might be used as a surrogate marker for visual damage in patients unable to perform perimetry.

La secuenciación masiva (NGS) como método diagnóstico en la enfermedad de Stargardt / Next generation sequencing in the diagnosis of Stargardt's disease

Introducción: La enfermedad de Stargardt es la maculopatía más frecuente en la edad infantil y adulta. Presenta un origen genético por afectación principalmente del gen ABCA4 con herencia autosómica recesiva. Se trata de un gen con características especiales por su gran tamaño y comportamiento, mostrando una elevada tasa de mutaciones. La aparición, desarrollo y accesibilidad económica de las técnicas de secuenciación masiva permiten realizar el diagnóstico genético de la enfermedad de Stargardt. Pacientes y métodos: Se presentan 2 casos clínicos diagnosticados genéticamente de enfermedad de Stargardt mediante la realización de un panel de secuenciación masiva de 298 genes. Resultados: Los pacientes presentaban un fenotipo de maculopatía de ojo de buey con ausencia de flecks y las siguientes mutaciones: c.G5882A:p.Gly1961Glu y c.C3056T:p.T1019M para el caso 1; c.G5882A:p.Gly1961Glu y c.287del:p.Asn96Thrfs·19 para el caso 2. Ambos pacientes comparten la mutación c.G588A:2p.Gly1961Glu que explica su fenotipo similar característico. Conclusiones: La secuenciación masiva es especialmente útil en la enfermedad de Stargardt, pues el gen ABCA4 presenta un gran tamaño y elevada heterogeneidad polimórfica, que se traduce en una amplia variabilidad clínica (AU)

Introduction: Stargardt's disease is the most frequent form of inherited macular dystrophy in children and adults. It is a genetic eye disorder caused by mutations in ABCA4 gene with an autosomal recessive inheritance. ABCA4 is a very polymorphic and large gene containing 50 exons. The development of next generation sequencing (NGS) can be used for the genetic diagnosis of this disease. Patients and methods: A report is presented on two patients with a clinical diagnosis of Stargardt's disease whose genetic confirmation was performed by a NGS panel of 298 genes. Results: Clinically, the patients showed bull's eye maculopathy and absence of flecks, and genetically they shared the Gly1961Glu mutation that could explain their common phenotype, together with c.C3056T:p.T1019M for case 1, and c.287del:p.Asn96Thrfs·19 for case 2. Conclusions: NGS is particularly useful in the diagnosis of Stargardt's disease as ABCA4 is a large gene with a high allelic heterogeneity that causes a wide range of clinical manifestations (AU)

Next generation sequencing in the diagnosis of Stargardt's disease. / La secuenciación masiva (NGS) como método diagnóstico en la enfermedad de Stargardt.

INTRODUCTION: Stargardt's disease is the most frequent form of inherited macular dystrophy in children and adults. It is a genetic eye disorder caused by mutations in ABCA4 gene with an autosomal recessive inheritance. ABCA4 is a very polymorphic and large gene containing 50 exons. The development of next generation sequencing (NGS) can be used for the genetic diagnosis of this disease. PATIENTS AND METHODS: A report is presented on two patients with a clinical diagnosis of Stargardt's disease whose genetic confirmation was performed by a NGS panel of 298 genes. RESULTS: Clinically, the patients showed bull's eye maculopathy and absence of flecks, and genetically they shared the Gly1961Glu mutation that could explain their common phenotype, together with c.C3056T:p.T1019M for case 1, and c.287del:p.Asn96Thrfs*19 for case 2. CONCLUSIONS: NGS is particularly useful in the diagnosis of Stargardt's disease as ABCA4 is a large gene with a high allelic heterogeneity that causes a wide range of clinical manifestations.

Cortical Blindness in a Child Secondary to Mycoplasma pneumoniae Infection.

Our objective is to present a case of an uncommon complication associated with Mycoplasma pneumoniae infection in a child where cortical blindness was the main clinical feature. Stroke due to an infection by M. pneumoniae is very uncommon. No consensus has been reached on the pathogenesis, although several pathogenic mechanisms have been proposed. Occlusion of posterior cerebral circulation is the most uncommon central nervous system complication of M. pneumoniae infection being reported. Symptoms are usually hemiplegia and dysarthria. We report a case of a 6-year-old boy who suffered cortical blindness due to a stroke 2 days after M. pneumoniae infection. This is the first case of documented cortical blindness due to posterior cerebral arteries occlusion in children after M. pneumoniae infection.

Forum for debate: Safety of allogeneic blood transfusion alternatives in the surgical/critically ill patient.

In recent years, several safety alerts have questioned or restricted the use of some pharmacological alternatives to allogeneic blood transfusion in established indications. In contrast, there seems to be a promotion of other alternatives, based on blood products and/or antifibrinolytic drugs, which lack a solid scientific basis. The Multidisciplinary Autotransfusion Study Group and the Anemia Working Group España convened a multidisciplinary panel of 23 experts belonging to different healthcare areas in a forum for debate to: 1) analyze the different safety alerts referred to certain transfusion alternatives; 2) study the background leading to such alternatives, the evidence supporting them, and their consequences for everyday clinical practice, and 3) issue a weighted statement on the safety of each questioned transfusion alternative, according to its clinical use. The members of the forum maintained telematics contact for the exchange of information and the distribution of tasks, and a joint meeting was held where the conclusions on each of the items examined were presented and discussed. A first version of the document was drafted, and subjected to 4 rounds of review and updating until consensus was reached (unanimously in most cases). We present the final version of the document, approved by all panel members, and hope it will be useful for our colleagues.

Parálisis del tercer nervio craneal y retinopatía de Purtscher en niña politraumatizada / Third cranial nerve palsy and Purtscher retinopathy in a child with multiple injuries

CASO CLÍNICO: Una niña de 4 años ingresa por politraumatismo grave por arrollamiento. Durante la evolución se le diagnostica de parálisis completa del tercer par del ojo derecho y retinopatía de Purtscher en ojo izquierdo. DISCUSIÓN: La retinopatía de Purtscher es poco frecuente. El diagnóstico es clínico y su tratamiento no está estandarizado aunque los corticoides sistémicos podrían mejorar el pronóstico visual. Las parálisis deL tercer par traumáticas tienen baja tendencia a la recuperación espontánea. El uso de toxina botulínica en niños podría mejorar la tasa de recuperación total y podría ser útil para acelerar la resolución y así permitir binocularidad y evitar la ambliopía

CASE REPORT: A 4 year-old girl was referred to our hospital after have suffered a severe accident. The patient was diagnosed with complete third nerve palsy in her right eye and Purtscher retinopathy in her left eye. DISCUSSION: Purtscher retinopathy is a rare condition. The diagnosis is made on clinical ground and its treatment is not well defined although it is believed that systemic steroids could improve the visual outcome. Traumatic third nerve palsy has a poor spontaneous recovery. The use of botulinum toxin might be useful in children to improve the recovery rate, maintaining binocularity, and avoiding amblyopia in other cases

[Third cranial nerve palsy and Purtscher retinopathy in a child with multiple injuries]. / Parálisis del tercer nervio craneal y retinopatía de Purtscher en niña politraumatizada.

CASE REPORT: A 4 year-old girl was referred to our hospital after have suffered a severe accident. The patient was diagnosed with complete third nerve palsy in her right eye and Purtscher retinopathy in her left eye. DISCUSSION: Purtscher retinopathy is a rare condition. The diagnosis is made on clinical ground and its treatment is not well defined although it is believed that systemic steroids could improve the visual outcome. Traumatic third nerve palsy has a poor spontaneous recovery. The use of botulinum toxin might be useful in children to improve the recovery rate, maintaining binocularity, and avoiding amblyopia in other cases.

Serie pediátrica en una campaña oftalmológica en Turkana (Kenia) / Pediatric case series in an ophthalmic camp in Turkana (Kenya)

Introducción: Turkana es el distrito más grande de Kenia, situado en el extremo noroeste. Su población está en torno a 850.000 habitantes seminómadas dedicados principalmente al pastoreo. En torno al 60% de la población vive por debajo del umbral de la pobreza. La proporción de médicos por habitante es de 1:75.000.La última campaña realizada en Turkana en noviembre de 2011, con un objetivo puramente quirúrgico, contó con cinco oftalmólogos. La selección previa fue realizada acertadamente por personal local en áreas rurales y en Lodwar. Se realizaron 128 cirugías (123 pacientes) sobre 371 pacientes vistos en consulta. Objetivo: Describir la población pediátrica atendida en la última campaña del proyecto oftalmológico en Turkana. Método: Descripción del perfil de afecciones oculares presentadas por los niños atendidos durante esta campaña quirúrgica. Se expondrá la actitud diagnóstico-terapéutica tomada con relación a las limitaciones impuestas por las características del lugar y de la población. Resultados: De un total de 371 pacientes vistos en consulta, 54 eran menores de 15 años (14,5%); cuatro fueron intervenidos, del total de 123 pacientes operados (3,25%). En dos niños más se indicó la cirugía, por lo que seis de los 54 casos se podrían considerar quirúrgicos (11,1%).De los 54 niños atendidos, 17 sufrían enfermedades distintas a defectos de refracción o problemas leves de superficie ocular: cataratas traumáticas, impétigo, neuropatías, proptosis, distrofias retinianas, tumores dermoides, nictalopía… En 4 de los 17 niños, la causa eran traumatismos (23,5%). Conclusiones: Las campañas quirúrgicas en países en vías de desarrollo están en auge, aunque suelen ir enfocadas a tratar afecciones concretas como las cataratas o el tracoma. Esta serie muestra la necesidad de ir equipados para intervenir a menores de edad y de estar preparados para la complejidad de la situación que pueda surgir (AU)

Introduction: Turkana is the largest district in Kenya, situated in the Northwest of the country. It features a semi-nomadic population of 850,000. Around 60% of population lives below the poverty threshold. The ratio of doctors is 1:75,000 inhabitants. Five ophthalmologists took part in the last deployment in November. Local staff had previously selected the patients from the rural areas, as well as in Lodwar, the capital of the district. Of the 371 patients who attended the clinic, 128 required surgery. Objetive: To describe the pediatric population attended to in the last «Turkana Eye Project» Camp. Methods: Description of the ophthalmic pathologies of the children seen in the clinic in this surgical camp, and the diagnostic and therapeutic options according to the limitations of the environment. Results: Of the 371 patients, 54 were younger than 15 years old (14.5%). Four children had surgery (3.25% of the 128 patients). In 2 more cases surgery was the indicated but not performed. Therefore, of the total of 54 cases, 6 could be considered as surgical (11.1%), and 17 suffered ophthalmic problems other than refraction defects, or mild ocular surface pathologies: traumatic cataracts, neuropathies, impetigo, exophthalmos, retinal dystrophies, dermoid cysts, or nyctalopia. The etiology was traumatic in four of the 17 children (23.5%). Conclusion: Surgical camps are increasing in the developing countries. They are usually focused on particular pathologies, such as cataracts or trachoma. Our case series shows the importance of pediatric teams and the need to be prepared to face complex pediatric pathologies (AU)

[Pediatric case series in an ophthalmic camp in Turkana (Kenya)]. / Serie pediátrica en una campaña oftalmológica en Turkana (Kenia).

INTRODUCTION: Turkana is the largest district in Kenya, situated in the Northwest of the country. It features a semi-nomadic population of 850,000. Around 60% of population lives below the poverty threshold. The ratio of doctors is 1:75,000 inhabitants. Five ophthalmologists took part in the last deployment in November. Local staff had previously selected the patients from the rural areas, as well as in Lodwar, the capital of the district. Of the 371 patients who attended the clinic, 128 required surgery. OBJETIVE: To describe the pediatric population attended to in the last «Turkana Eye Project¼ Camp. METHODS: Description of the ophthalmic pathologies of the children seen in the clinic in this surgical camp, and the diagnostic and therapeutic options according to the limitations of the environment. RESULTS: Of the 371 patients, 54 were younger than 15 years old (14.5%). Four children had surgery (3.25% of the 128 patients). In 2 more cases surgery was the indicated but not performed. Therefore, of the total of 54 cases, 6 could be considered as surgical (11.1%), and 17 suffered ophthalmic problems other than refraction defects, or mild ocular surface pathologies: traumatic cataracts, neuropathies, impetigo, exophthalmos, retinal dystrophies, dermoid cysts, or nyctalopia. The etiology was traumatic in four of the 17 children (23.5%). CONCLUSION: Surgical camps are increasing in the developing countries. They are usually focused on particular pathologies, such as cataracts or trachoma. Our case series shows the importance of pediatric teams and the need to be prepared to face complex pediatric pathologies.