Respiratory syncytial virus: A new era.

Respiratory syncytial virus (RSV) is a major public health problem that has undergone significant changes in recent years. First of all, it has become easier to diagnose with highly reliable and rapidly available confirmatory tests. This has led to a better understanding of its epidemiology and RSV has gone from being a disease of the pediatric age group, severe only in infants and immunosuppressed children, to being a common disease in people of all ages, particularly important in patients of advanced age or with immunosuppressive diseases. Recent therapeutic and prophylactic advances, both with long-lasting monoclonal antibodies and vaccines, are another reason for satisfaction. For these reasons, the COVID and Emerging Pathogens Committee of the Illustrious Official College of Physicians of Madrid (ICOMEM) has considered it pertinent to review this subject in the light of new knowledge and new resources for dealing with this infection. We have formulated a series of questions that we believe will be of interest not only to members of the College but also to any non-expert in this subject, with a particular focus on the situation of RSV infection in Spain.

[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.

Site-bond percolation solution to preventing the propagation of Phytophthora zoospores on plantations.

We propose a strategy based on the site-bond percolation to minimize the propagation of Phytophthora zoospores on plantations, consisting in introducing physical barriers between neighboring plants. Two clustering processes are distinguished: (i) one of cells with the presence of the pathogen, detected on soil analysis, and (ii) that of diseased plants, revealed from a visual inspection of the plantation. The former is well described by the standard site-bond percolation. In the latter, the percolation threshold is fitted by a Tsallis distribution when no barriers are introduced. We provide, for both cases, the formulas for the minimal barrier density to prevent the emergence of the spanning cluster. Though this work is focused on a specific pathogen, the model presented here can also be applied to prevent the spreading of other pathogens that disseminate, by other means, from one plant to the neighboring ones. Finally, the application of this strategy to three types of commercially important Mexican chili plants is also shown.

La Sección de Hospitalaización de Pediatría del Hospital Materno Infantil Gregorio Marañón en 2016 / Pediatric Hospitalization Section of the Hospital Materno Infantil Gregorio Marañón in 2016

Entre los objetivos principales de la hospitalización pediátrica en un hospital terciario se incluyen el cuidado integral de los pacientes pediátricos ingresados incluyendo aspectos diagnósticos, curativos, preventivos y de rehabilitación. La Academia Americana de Pediatría reconoció hace más de 20 años la importancia y el papel crucial de los programas de hospitalización pediátrica. Así, la Pediatría General en un hospital terciario juega un papel muy importante en el cuidado agudo de pacientes pediátricos con patologías prevalentes, pero también como coordinador e integrador del cuidado de pacientes crónicos y de alta complejidad. También creemos que la Pediatría General en un hospital terciario tiene la responsabilidad de desarrollar los programas de calidad, implantar una cultura de seguridad en Pediatría, promover protocolos y guías clínicas en patologías prevalentes, ser referentes en la educación de los familiares de nuestros pacientes así como desarrollar los programas de e-health y cooperación internacional (AU)

The main objectives of the Pediatric Hospitalist Programs within a Tertiary Hospital include comprehensive care to hospitalized pediatric patients in diagnostic, curative, preventive, and rehabilitation aspects. The American Academy of Pediatrics recognized about 20 years ago, the importance and the key role of Pediatrics Hospitalist programs. General Pediatrics plays an important role not only for the care in acute prevalent pathologies, but also as a coordinator and integrator in chronic and highly complex patients. We also believe that General Pediatrics at a Third level hospital, has the responsibility to develop quality programs, implement safety culture in hospitalized patients, promote protocols and clinical guidelines in prevalent pathologies, health education in our population, and developing e-health and international cooperation programs (AU)

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.

Control de la concentración de metilmercurio en productos pesqueros para el consumo humano mediante el empleo de polímeros de impronta molecular y de nanopartículas derivatizadas / Control of the methylmercury concentration in fish and seafood products for human consumption using molecularly imprinted polymers (MIPs) and derivatized nanoparticles

Objetivo: Desarrollar un polímero de impronta molecular para la determinación de metilmercurio en muestras de alimentos de origen marino. Material y métodos: Se sintetizó un polímero de impronta molecular (MIP) que emplea fenobarbital como ligando no vinilado para unirse al metilmercurio. Se utilizó la técnica de polimerización por precipitación. El MIP sintetizado fue empleado para funcionalizar nanopartículas magnéticas con el fin de mejorar el proceso de extracción del metilmercurio de las muestras. Resultados: El MIP con fenobarbital fue aplicado para la determinación de la concentración de metilmercurio en dos materiales de referencia de concentración certificada para el análisis de muestras de alimentos marinos (BCR-463, tejido de atún, y TORT-2, hepatopáncreas de langosta). Los valores de concentración experimentales obtenidos fueron de 3,04±0,16 μg/g y 0,152±0,013 μg/g respectivamente, coincidiendo con los valores certificados de forma estadísticamente significativa (test t, 95% confianza). Conclusiones: Se ha sintetizado un MIP para la determinación de la concentración de metilmercurio a bajas concentraciones en muestras de alimentos de origen marino (AU)

Objective: The development of a molecularly imprinted polymer support for methylmercury determination in fish and seafood samples. Materials and methods: A molecularly imprinted polymer was synthesized using the precipitation technique and phenobarbital as a non-vinylated ligand for binding methylmercury. The synthesized MIP was used for the functionalization of magnetic nanoparticles in order to improve the process of methylmercury extraction from the samples. Results: The MIP prepared with phenobarbital was applied to the determination of methylmercury concentration in two certified reference materials used for fish and seafood samples analysis (BCR-463, tuna fish, and TORT-2, lobster hepatopancreas). The experimental values (3.04±0.16 μg/g and 0.152±0.013 μg/g respectively) and the certified values showed no statistically significant difference (t test, 95% confidence level). Conclusions: We have synthesized a MIP for determining methylmercury in fish and seafood samples at low concentrations (AU)

Serotipos no vacunales emergentes causantes de enfermedad neumocócica invasora en la era de la vacuna 7-valente / Emergence of invasive pneumococcal disease caused by non-vaccine serotypes in the era of the 7-valent conjugate vaccine

INTRODUCCIÓN: Tras la introducción de la VNC7 se ha objetivado una importante expansión de algunos serotipos emergentes (SNV) de Streptococcus pneumoniae, siendo los principales productores de enfermedad neumocócica invasora (ENI) actualmente. Nuestro objetivo ha sido describir los aspectos epidemiológicos, clínicos y microbiológicos de la ENI producida por SNV en un hospital terciario de Madrid. PACIENTES Y MÉTODOS: Estudio retrospectivo (1998-2004) y prospectivo (2005-2009) de los SNV productores de ENI. Se analizaron 3 periodos de estudio: P1 (1998-2001), sin comercialización de la VNC7, P2 (2002-2005), con una cobertura vacunal del 40% y P3 (2006-2009), con la vacuna incorporada al calendario vacunal de la Comunidad de Madrid. RESULTADOS: Se analizaron 155 casos de ENI, de los que se pudieron serotipar 150 aislamientos (100 de ellos SNV). Se produjo un incremento de la prevalencia de SNV desde P1 (31%) a P2 (53,6%) y P3 (91,3%). Los serotipos emergentes más prevalentes fueron 19A, 1, 5, 3, 7 F y 15C. Los serotipos 1, 3, 5 y 15C produjeron, fundamentalmente, enfermedad respiratoria; el serotipo 19A tanto enfermedad respiratoria como bacteriemia primaria, siendo la principal causa de meningitis; el serotipo 7 F produjo, fundamentalmente, bacteriemia primaria (66%). El 83,8% de los SNV fueron sensibles a penicilina. CONCLUSIONES: Desde la introducción de la VNC7 se ha objetivado un aumento de la prevalencia de ENI producida por SNV. Estos cambios encontrados deberían hacer considerar la utilización de las vacunas antineumocócicas ampliadas para la prevención de ENI, al incluir la mayoría de los SNV emergentesies

INTRODUCTION: There has been an increased incidence in invasive pneumococcal disease (IPD) produced by non-vaccine serotype (NVS) of Streptococcus pneumoniae after the introduction of PCV7. Our objective was to describe the epidemiological, clinical and microbiological characteristics of IPD caused by NVS in a tertiary hospital in Madrid. PATIENTS AND METHODS: Retrospective (1998-2004) and prospective (2005-2009) study evaluating IPD caused by NVS in children. The study was divided into three periods: P1 (1998-2001) when PCV7 was not commercialized; P2 (2002-2005) with 40% vaccine coverage among children; andP3 (2006-2009) when the vaccine was added to the Childhood Immunization Schedule in Madrid. RESULTS: We analyzed 155 cases of IPD. One hundred and fifty of these isolates were serotyped (100 were NVS). There was an increase in the prevalence of IPD from P1 (31%) to P2 (54%) and P3 (91%). The most relevant emerging serotypes were 19A, 7 F, 1, 5, 3 and 15C. The most significant clinical syndromes produced by some specific serotypes were as follows: lower respiratory tract infection (LRTI) by serotypes 1, 3, 5 and 15C; LRTI, primary bacteremia and meningitis by serotype 19A; and primary bacteremia by serotype 7 F (66%). The large majority (83.8%) of NVS were sensitive to penicillin. CONCLUSIONS: There has been an increased prevalence of IPD caused by NVS since the introduction of PCV7. These changes should prompt the introduction of new pneumococcal vaccines, which include most of the NVS, in the childhood immunization calendar to prevent IPD in children

Terapia de alto flujo en hospitalización pediátrica. Nuevo horizonte en el tratamiento de la bronquiolitis. Respuesta de los autores / High-flow therapy during paediatric admissions: A new horizon in the treatment of bronchiolitis. Reply by the authors

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Pólipo antropilórico en la enfermead de Menkes / Antropyloric polyp in Menkes disease

Presentamos el caso de un lactante diagnosticado de enfermedad de Menkes en tratamiento sustitutivo con cobrehitidina que presentó un cuadro de pseudoobstrucción instestinal con hemorragia digestiva alta. La aparición de pólipos gastrointestinales por hiperplasia mucosa en la enfermedad de Menkes puede asociar importante morbimortalidad y no se previenen con el tratamiento enzimático, precisando resección endoscópica o quirúrgica (AU)

We present a case of an infant with Menkes disease treated with copper-histidine replacement therapy who developed an intestinal pseudo-obstruction with upper gastrointestinal mucosa and polyps is related to significant morbidity in Menkes disease. We can not prevent them with enzyme treatment so it usually need endoscopic or surgical resection (AU)

[Emergence of invasive pneumococcal disease caused by non-vaccine serotypes in the era of the 7-valent conjugate vaccine]. / Serotipos no vacunales emergentes causantes de enfermedad neumocócica invasora en la era de la vacuna 7-valente.

INTRODUCTION: There has been an increased incidence in invasive pneumococcal disease (IPD) produced by non-vaccine serotype (NVS) of Streptococcus pneumoniae after the introduction of PCV7. Our objective was to describe the epidemiological, clinical and microbiological characteristics of IPD caused by NVS in a tertiary hospital in Madrid. PATIENTS AND METHODS: Retrospective (1998-2004) and prospective (2005-2009) study evaluating IPD caused by NVS in children. The study was divided into three periods: P1 (1998-2001) when PCV7 was not commercialized; P2 (2002-2005) with 40% vaccine coverage among children; and P3 (2006-2009) when the vaccine was added to the Childhood Immunization Schedule in Madrid. RESULTS: We analyzed 155 cases of IPD. One hundred and fifty of these isolates were serotyped (100 were NVS). There was an increase in the prevalence of IPD from P1 (31%) to P2 (54%) and P3 (91%). The most relevant emerging serotypes were 19A, 7F, 1, 5, 3 and 15C. The most significant clinical syndromes produced by some specific serotypes were as follows: lower respiratory tract infection (LRTI) by serotypes 1, 3, 5 and 15C; LRTI, primary bacteremia and meningitis by serotype 19A; and primary bacteremia by serotype 7F (66%). The large majority (83.8%) of NVS were sensitive to penicillin. CONCLUSIONS: There has been an increased prevalence of IPD caused by NVS since the introduction of PCV7. These changes should prompt the introduction of new pneumococcal vaccines, which include most of the NVS, in the childhood immunization calendar to prevent IPD in children.

Aumento de la incidencia de enfermedad neumocócica invasora producida por el serotipo 19A previo a la introducción de las vacunas neumocócicas ampliadas / Increase in the incidence of invasive pneumococcal disease caused by serotype 19A prior to the implementation of the expanded pneumococcal vaccines

Objetivo: Describir los aspectos epidemiológicos, clínicos y microbiológicos del serotipo 19A como principal productor de enfermedad neumocócica invasiva (ENI) en un hospital terciario de la Comunidad de Madrid (CAM). Métodos: Estudio retrospectivo (1998-2004) y prospectivo (2005-2009) del serotipo 19A como agente productor de ENI en pediatría entre 1998-2009. Se analizaron 3 periodos de estudio: P1 (1998-2001), previo a la comercialización de la VNC7; P2 (2002-2005), con una cobertura vacunal de 40%, y P3 (2006-2009), cuando la vacuna fue incorporada al calendario vacunal de la CAM. Resultados: Se analizaron un total de 155 muestras de Streptococcus pneumoniae (S. pneumoniae) productoras de ENI; 21 casos producidos por el serotipo 19A (14%). Se detectó un aumento de la prevalencia del serotipo 19A: 2 casos de un total de 45 en P1 (4,4%), 3 de 41 casos en P2 (7,3%) y 16 de 69 casos en P3 (23,2%). Afectó, principalmente, a niños menores de 2 años (16/21; 76%), siendo, globalmente, el principal productor de meningitis (5/20; 25%), así como de empiema pleural (3/22; 14%) y mastoiditis bacteriémica (2/4; 50%). Trece aislamientos (61,5%) presentaron una CMI ≥ 0,12 μ/ml para penicilina en infecciones extrameníngeas y 3 de los 5 casos de meningitis (60%) presentaron una CMI ≥ 1 μ/ml para cefotaxima. Conclusiones: El serotipo 19A se convirtió en el principal agente etiológico productor de ENI en la era de la VNC7 (P3), asociando altas tasas de resistencia antibiótica. Este serotipo produjo todas las formas clínicas de ENI, siendo el principal causante de meningitis (AU)

Objective: To describe the epidemiology, clinical syndromes and microbiological characteristics of serotype 19A as the main cause of invasive pneumococcal disease (IPD) in children admitted to a tertiary hospital in Spain. Methods: A retrospective (1998-2004) and prospective (2005-2009) study was conducted on children with IPD produced by serotype 19A. The study was divided into three periods (P):P1 (1998-2001) when PCV7 had not been commercialized; P2 (2002-2005) with 40% vaccine coverage among children; and P3 (2006-2009) when the vaccine was added to the Childhood Immunization Schedule in Madrid. Results: A total of 155 isolates of Streptococcus pneumoniae (SP) producing IPD were analysed ,with 21 of them being serotype 19A (14%). An increased prevalence of serotype 19A was found:2/45 cases (4.4%) in P1, 3/41 cases (7.3%) in P2 and 16/69 cases (23.2%) in P3. It occurred mostly in children younger than 2 years (16/21; 76%). This serotype was the main cause of meningitis (5/20; 25%), pleural empyema (3/22; 14%) and bacteraemic mastoiditis (2/4; 50%). Thirteen isolates (61.5%) had an MIC ≥0.12 μ/ml for penicillin in extra-meningeal infections, and 3 of the 5 isolates causing meningitis (60%) had an MIC ≥1 μ/ml for cefotaxime. Conclusions: Serotype 19A was the main causal agent of IPD in the PCV7 era (P3), with high antibiotic resistance rates. This serotype was responsible for all types of IPD, being the main cause of meningitis (AU)

[Increase in the incidence of invasive pneumococcal disease caused by serotype 19A prior to the implementation of the expanded pneumococcal vaccines]. / Aumento de la incidencia de enfermedad neumocócica invasora producida por el serotipo 19A previo a la introducción de las vacunas neumocócicas ampliadas.

OBJECTIVE: To describe the epidemiology, clinical syndromes and microbiological characteristics of serotype 19A as the main cause of invasive pneumococcal disease (IPD) in children admitted to a tertiary hospital in Spain. METHODS: A retrospective (1998-2004) and prospective (2005-2009) study was conducted on children with IPD produced by serotype 19A. The study was divided into three periods (P): P1 (1998-2001) when PCV7 had not been commercialized; P2 (2002-2005) with 40% vaccine coverage among children; and P3 (2006-2009) when the vaccine was added to the Childhood Immunization Schedule in Madrid. RESULTS: A total of 155 isolates of Streptococcus pneumoniae (SP) producing IPD were analysed, with 21 of them being serotype 19A (14%). An increased prevalence of serotype 19A was found: 2/45 cases (4.4%) in P1, 3/41 cases (7.3%) in P2 and 16/69 cases (23.2%) in P3. It occurred mostly in children younger than 2 years (16/21; 76%). This serotype was the main cause of meningitis (5/20; 25%), pleural empyema (3/22; 14%) and bacteraemic mastoiditis (2/4; 50%). Thirteen isolates (61.5%) had an MIC ≥ 0.12µ/ml for penicillin in extra-meningeal infections, and 3 of the 5 isolates causing meningitis (60%) had an MIC ≥ 1µ/ml for cefotaxime. CONCLUSIONS: Serotype 19A was the main causal agent of IPD in the PCV7 era (P3), with high antibiotic resistance rates. This serotype was responsible for all types of IPD, being the main cause of meningitis.

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.

Reducción de las amputaciones con heberprot p en la terapia local del pie diabético / Reduction in the amputation rate with heberprot p in the local treatment of diabetic foot

INTRODUCCIÓN. El síndrome de Pie diabético, se ha convertido en un problema sanitario mundial, por su alta frecuencia, recidiva y costos, a su vez, la frecuencia de ulceración y amputación aumenta progresivamente. Pretendemos a través de la siguiente investigación demostrar el impacto en la reducción de las tasa de amputaciones por Pie diabético asociada al uso del Heberprot P. MÉTODOS. Diseñamos un estudio analítico retrospectivo con los pacientes ingresados con el diagnóstico de Pie diabético en el Servicio Provincial de Angiología y Cirugía Vascular del Hospital Clínico-Quirúrgico Docente de Matanzas José R. López Tabrane, entre enero del 2007 y septiembre del 2010 incluyendo ambos. De ellos seleccionamos nuestra muestra consistente en 2 grupos: Grupo A En los cuáles se empleo la terapia convencional aplicada a esta entidad y Grupo B en los cuales además de la terapia convencional, se utilizó localmente el heberprot P. RESULTADOS. Se aprecia una significativa reducción de la frecuencia de amputaciones en el grupo tratado con heberprot P en comparación con la terapia convencional, demostrando su utilidad en los grados 3,4 y 5 de Wagner y en las lesiones tanto neuropáticas como neuroisquémicas, observándose a su vez una marcada reducción en el tiempo de granulación y epitelización con el empleo del mismo. Hechos todos que avalan la importancia de su empleo local en el pie diabético (AU)

SUMMARY BACKGROUND. The diabetic foot syndrome (DFS), has become in a world sanitary problem, by its high frequency and cost, is important also for the increase in the prevalence of ulceration and amputation. Is objective of this investigation to demonstrate the impact in the reduction of the amputation rate for DFS associated with the use of the heberprot P. METHODS. The design of the investigation is retrospective, analytic with the patients admitted with the diagnosis of DFS in the provincial service of vascular surgery of the University Clinical Surgical Hospital of Matanzas Jose R. Lopez Tabrane, from January 2007 to September of 2010, including both. From this we select our population that consist of 2 groups. Group A that use conventional therapy and Group B in witch associated to the conventional therapy we use local treatment with heberprot P. RESULTS. We obtain a significative reduction in the amputation rate in the group that received local treatment with heberprot P when a comparison is established with a conventional treatment, the effectiveness is observe for the groups 3,4 and 5 of the Wagner classification and in the neuropatic and neuroischemics ulcers, with a reduction in the granulation and epithelisation time. Facts that show the importance of this local treatment in the wound healing of the DFS (AU)

Reducción de las amputaciones con Heberprot P en la terapia local del pie diabético / Reduction in the amputation rate with Heberprot P in the local treatment of diabetic foot

INTRODUCCIÓN. El síndrome de Pie diabético, se ha convertido en un problema sanitario mundial, por su alta frecuencia, recidiva y costos, a su vez, la frecuencia de ulceración y amputación aumenta progresivamente. Pretendemos a través de la siguiente investigación demostrar el impacto en la reducción de las tasa de amputaciones por Pie diabético asociada al uso del Heberprot P. MÉTODOS. Diseñamos un estudio analítico retrospectivo con los pacientes ingresados con el diagnóstico de Pie diabético en el Servicio Provincial de Angiología y Cirugía Vascular del Hospital Clínico-Quirúrgico Docente de Matanzas José R López Tabrane, entre enero del 2007 y septiembre del 2010 incluyendo ambos. De ellos seleccionamos nuestra muestra consistente en 2 grupos: Grupo A En los cuáles se empleo la terapia convencional aplicada a esta entidad y Grupo B en los cuales además de la terapia convencional, se utilizó localmente el heberprot P. RESULTADOS. Se aprecia una significativa reducción de la frecuencia de amputaciones en el grupo tratado con heberprot P encomparación con la terapia convencional, demostrando su utilidad en los grados 3,4 y 5 de Wagner y en las lesiones tanto neuropáticas como neuroisquémicas, observándose a su vez una marcada reducción en el tiempo de granulación y epitelización con el empleo del mismo. Hechos todos que avalan la importancia de su empleo local en el pie diabético(AU)

BACKGROUND. The diabetic foot syndrome (DFS), has become in a world sanitary problem, by its high frequency and cost, is important also for the increase in the prevalence of ulceration and amputation. Is objective of this investigation to demonstrate the impact in the reduction of the amputation rate for DFS associated with the use of the heberprot P. METHODS. The design of the investigation is retrospective, analytic with the patients admitted with the diagnosis of DFS in the provincial service of vascular surgery of the University Clinical Surgical Hospital of Matanzas Jose R. Lopez Tabrane, from January 2007 to September of 2010, including both. From this we select our population that consist of 2 groups. Group A that use conventional therapy and Group B in witch associated to the conventional therapy we use local treatment withheberprot P. RESULTS. We obtain a significative reduction in the amputation rate in the group that received local treatment with heberprotP when a comparison is established with a conventional treatment, the effectiveness is observe for the groups 3,4 and 5 of the Wagner classification and in the neuropatic and euroischemics ulcers, with a reduction in the granulation and epithelisation time. Facts that show the importance of this local treatment in the wound healing of the DFS(AU)

Evolución de la prescripción de antibióticos en un servicio de urgencias pediátricas / Evolution of the antibiotics prescription in a pediatric emergency service

Objetivo: Describir la calidad de prescripción antibiótica en un servicio de urgencias pediátrico, antes y después de la realización de dos sesiones formativas sobre el «uso racional de antibióticos». Material y métodos: Estudio descriptivo y retrospectivo de los pacientes dados de alta en urgencias durante el mes de enero de 2008, respecto a diciembre de 2008-enero de 2009. Se recogieron los datos sociodemográficos y relacionados con el diagnóstico y el tratamiento de los pacientes que recibían tratamiento antimicrobiano. Se valoró la posología y la indicación según las vías clínicas validadas de nuestro hospital. Entre ambos periodos, se impartieron dos sesiones formativas sobre el uso racional de antibióticos. Resultados: En enero de 2008 se revisaron 5.989 informes de alta, y se pautaron antibióticos al 13% de los niños. En el segundo periodo se revisaron 6.359 informes, y recibieron antibióticos un 12,7%. Los diagnósticos más frecuentes fueron la faringoamigdalitis aguda (49,6%) en el primer periodo y la otitis media (39%) en el segundo. La indicación fue correcta en el 90,7%en el primer periodo, frente al 84,7% en el segundo (p <0,01), la dosificación fue adecuada en el 79,4 frente al 86% (p <0,01), y la duración fue correcta en el 88,6% en ambos periodos. Se prescribieron más antibióticos durante el turno de noche y en días festivos. Conclusiones: El porcentaje de antibióticos prescritos es similar al de otras series. Tras las sesiones formativas sobre el manejo correcto de la antibioterapia, no ha disminuido su prescripción. Aunque se dosifica mejor, ha aumentado el porcentaje de indicación incorrecta. Serían necesarias más medidas para mejorar la calidad de prescripción antimicrobiana (AU)

Objective: To describe the quality of antibiotic prescription in the pediatric emergency service before and after two educational talks regarding “the rational use of antibiotics”. Material and methods: Descriptive, retrospective study of all the discharged patients evaluated in the emergency service during the month of January 2008 compared to December 2008 and January 2009. Demographic, social, diagnostic and treatment parameters of children who received antimicrobials treatment were analyzed. Dosage and indication were evaluated according to the validated clinical guidelines of the hospital, between both periods’ formative sessions about the rational use of antibiotics. Results: In January 2008 we reviewed 5,989 medical discharge records and found that 13% of the children had received antibiotics. We also reviewed 6,359 records from the second period and found that 12.7% of the children had received antibiotic therapy. The most frequent diagnoses were acute pharyngotonsillitis (49.6%) in the first period and acute otitis media (39%) in the second period. The indication and dosage were correct in 90.7% and 79.4% of the cases in the first period compared to 84.7% and 86% in the second period (p <0.01) respectively. The duration of therapy was correct in 88.6% of cases in both periods. Antibiotics were more frequently prescribed at the night shift and on holidays. Conclusions: The percentage of antibiotic prescription in this study is similar to that of other series and did not decrease after educational talks regarding the rational use of antibiotics. Although there was an increase in the correct dosage prescribed the percentage of incorrect antibiotic indications increased as well. Further actions should be taken to improve the quality of antibiotic prescriptions (AU)

First Report of Powdery Mildew on Carrot Caused by Erysiphe heraclei in Michoacan, Mexico.

Carrot (Daucus carota L. subsp. sativus (Hoffm.) Arcang.) is planted as a home-grown vegetable in the central region of Michoacan, Mexico. Powdery mildew was observed on carrot plants cv. Nantesa at several locations near Morelia, Michoacan during March 2009. Affected plants had abundant, white, superficial conidia and mycelium on leaves and stems. All plants at each of five locations surveyed had powdery mildew symptoms with percent foliage coverage ranging from 50 to 80%. Mycelial growth was amphigenous, mainly on the upper leaf surface, covering the whole leaf and with irregular patches on inflorescences and stems. Hyphae were ectophytic with lobed appressoria. Conidiophores presented foot cells 22.5 to 35 (30) × 5.75 to 7 (6.3) µm followed by two cells, one shorter and one longer than the foot cell. Conidia were produced singly, most subcylindric to cylindric, lacked fibrosin bodies, and measured 31.2 to 42 (36.2) × 8.7 to 11.2 (10.5) µm. The teleomorph was not observed. Genomic DNA was extracted from infected leaves; sequences of the internal transcribed spacers (ITS) inclusive of 5.8S rDNA were amplified using previously described primers specific for Erysiphales (3). The ITS sequences shared 100% homology to Erysiphe heraclei specimen VPRI41227 from carrot in Australia (GenBank Accession No. EU371725). On the basis of the morphological characteristics observed and the ITS rDNA sequences, the pathogen was identified as E. heraclei DC. The ITS sequence was deposited in NCBI as Accession No. GU252368. Pathogenicity tests were conducted twice on a total of 10 healthy 8-week-old carrot plants cv. Nantesa. Infected plants were placed in close proximity to healthy plants and maintained in a greenhouse at 27 ± 5°C. Initial signs and symptoms were observed 3 weeks after inoculation and appeared as small, white colonies, which later coalesced and covered most of the foliage. Microscopic examination of the conidia and mycelial morphology matched the originally described pathogen, E. heraclei. Powdery mildew caused by this pathogen has been extensively reported on diverse species and genera of the Apiaceae in Europe and remains one of the most important diseases of carrot (2). The appearance of E. heraclei in diverse regions on a variety of umbelliferous crops indicates that formae speciales have spread, infecting different and specific hosts (1-3). Recently, E. heraclei has been reported on parsley in Puebla, Mexico (4). To our knowledge, this is the first report of E. heraclei causing powdery mildew on carrot in Michoacan, Mexico. This pathogen should be considered as a threat to commercial carrot crops in Mexico. Other crops in the Apiaceae may not be at risk in this area if this powdery mildew is specific for carrots. References: (1) B. J. Aegerter. Page 22 in: Compendium of Umbelliferous Crop Diseases. The American Phytopathological Society, St. Paul, MN, 2002. (2) U. Braun. The Powdery Mildew (Erysiphales) of Europe. Gustav Fischer-Verlag. Jena, Germany, 1995. (3) J. H. Cunnington et al. Australas. Plant Pathol. 32:421, 2003. (4) M. J. Yáñez-Morales et al. Schlechtendalia 19:47, 2009.

Root Rot of Hydroponically Grown Lettuce Caused by Phytophthora drechsleri in Mexico.

During March of 2008, bibb lettuce (Lactuca sativa L.) plants with severe wilting and root rot were observed in a commercial liquid-hydroponic greenhouse in Guanajuato, Mexico. By July of that year, the disease affected most plants in the facility. A Phytophthora sp. was consistently isolated from diseased roots on potato carrot agar. Several Phytophthora isolates were morphologically characterized. Sporulation was achieved by placing colonized disks of clarified V8 juice agar (V8A) into nonautoclaved soil extract (10 g avocado soil/1,000 ml distilled water, stirred for 3 h, and filtered). Sporangia were persistent, nonpapillate, and 40 to 58 µm long × 30 to 40 µm wide. External and internal proliferation was observed. Hyphal swellings were predominantly rounded. Oospores were not observed. The isolates grew on V8A at 35°C. Pathogenicity tests were conducted twice by utilizing a representative isolate (AC1) on bibb lettuce seedlings (10 replicates per experiment). Seeds were placed on sterile, water-soaked paper in petri dishes. After 10 days, each lettuce seedling was placed into a tube containing approximately 2 ml of sterile distilled water and 2,000 zoospores. Control plants were placed in tubes with water only. Plants were incubated for 7 days in a moist chamber at 25°C. Symptoms of wilting and root necrosis were observed 2 to 3 days after inoculation. All plants were dead 5 to 7 days after inoculation. A Phytophthora sp. was always isolated from the roots of inoculated plants. Control plants remained healthy. The pathogen was identified as Phytophthora drechsleri Tucker according to morphological characteristics. To confirm the identity of the pathogen, sequences of the internal transcribed spacers (ITS) were obtained from three representative isolates. The ITS sequences that were obtained shared 100% homology to several strains of P. dreschleri, including isolates from cucurbits (GenBank Accession No. AF228097). The ITS sequence was deposited in NCBI as Accession No. FJ790770. P. cryptogea and P. dreschleri have been reported as causing root rot on lettuce grown hydroponically in the United States and Korea (1,2). To our knowledge, this is the first report of P. drechsleri causing root rot on lettuce in Mexico. References: (1) H. J. Jee et al. Plant Pathol. J. 17:311, 2001. (2) A. R. Linde et al. Plant Dis. 74:1037, 1990.