Congenital and Neonatal Chikungunya in Colombia.

In Latin America and the Caribbean (LAC), chikungunya (CHIK) viral infection has emerged as a significant arboviral disease. This rapidly expanding vector-borne viral illness is associated with a substantial burden of disease in terms of acute illness and also in terms of long-term sequelae. In addition, this viral pathogen has the ability to impact different populations including pregnant women and newborns. Despite the growing threat of this arboviral infection to the region, there are insufficient reports or studies attempting to delineate the clinical and epidemiological features of congenital and neonatal cases of CHIK in LAC. In this study, we present a case of congenital CHIK and a case of neonatal CHIK infection identified in Santander, Colombia. We discuss the potential neurological impact and sequelae of CHIK infection acquired during the neonatal period. There is an urgent need for further epidemiological and clinical studies to better understand the impact of CHIK in endemic areas in LAC.

Sub-micrometric reflectometry for localized label-free biosensing.

In this work we present an optical technique for characterizing sub-micrometric areas based on reflectivity of the light as a function of angle of incidence for the two pure polarizations s and p, covering a range of angles of incidence from -71.80° to 71.80° with a resolution of 0.1°. Circular areas with a diameter in the order of 600 nm can be characterized, and the spectra for the two polarizations can be obtained with a single measurement. For biosensing purposes, we have fabricated several Bio Photonic Sensing Cells (BICELLs) consisting of interferometers of 1240 nm of SU-8 polymer over silicon. An indirect immunoassay is performed over these BICELLs and compared experimentally with FT-VIS-NIR spectrometry and theoretical calculations. The Limit of Detection (LoD) achieved is comparable with standard high resolution spectrometry, but with the capability of analyzing sub-micrometric domains for immunoassays reactions onto a sensing surface.

Reticulated platelets as a screening test to identify thrombocytopenia aetiology.

BACKGROUND: Thrombocytopenia is a common haematological abnormality and no simple diagnostic test is available to diagnose thrombocytopenia pathogenesis. AIM: To evaluate sensitivity and specificity of reticulated platelets (RP) as a diagnostic test for thrombocytopenia with increased thrombopoietic activity. DESIGN: Prospective observational study in thrombocytopenic patients. METHODS: A direct, whole-blood, dual-labelling flow cytometric method was used. Direct, whole-blood double coverage was achieved using a monoclonal anti-glycoprotein (GP)-III antibody (CD61 PerCP) for platelet identification and thiazole orange (Retic-count) as platelet mARN stain. RESULTS: RP were measured in 101 thrombocytopenic patients and 104 non-thrombocytopenic controls. The mean RP percentage in 60 thrombocytopenic patients with no increased thrombopoietic activity was 7.5% (CI for 95%: 5.2-9.7) and RP absolute number was 3.2 x 10(9)/l (CI for 95%: 2.1-4.3). The mean RP percentage in 41 thrombocytopenic patients with increased thrombopoietic activity was 30.3% (CI for 95%: 25.1-35.5) and RP absolute number was 6.2 (CI for 95%: 4.8-7.7). The RP percentage cut-off for a diagnosis of thrombocytopenia with increased thrombopoietic activity was 11% [sensitivity 93%, specificity 85%, positive predictive value (PPV) 83%, negative predictive value (NPV) 95%]. CONCLUSION: RP measurement by flow cytometry, directly from whole-blood, is a useful screening test to differentiate between thrombocytopenia with high or low thrombopoietic activity. A RP percentage in excess of 11%, has a high sensitivity and good specificity for a diagnosis of thrombocytopenia with increased thrombopoietic activity.

[Family impact of rotavirus gastroenteritis in children under two years]. / Impacto familiar de la gastroenteritis por rotavirus en menores de dos años.

INTRODUCTION: Acute gastroenteritis (AGE) in infants has a significant impact on the quality of life of their parents. MATERIAL AND METHODS: Cross-sectional study on the sociological family impact related to rotavirus AGE in children under 2 years. The study was carried out in 25 hospitals and 5 primary care centres in Spain. Sociodemographic, epidemiological and clinical data were recorded, as well as the symptomatology of AGE and its severity measured by the Clark scale. Stool samples were tested to determine rotavirus positive (RV+) or negative (RV-). The parents were asked to complete a a family impact questionnaire. RESULTS: Stool specimens were tested in 1087 AGE cases (584 RV+ vs 503 RV-). The 99.5 % of parents whose children were RV+ reported more worries vs. the 97.7 % of RV-, and RV+ had a higher importance score (p < 0.05). A higher percentage of RV+ parents and those with a high importance score reported more time dedicated to dehydration treatment (p < 0.05). The 82.5 % vs. 73.9 % had disruption of their household tasks, with more importance scores (p < 0.05). RV+ had a higher percentage and importance score than RV- ones in all aspects of their child's AGE symptoms, except loss of appetite. CONCLUSION: AGE produces important dysfunctional experiences in daily family life. According to parental perceptions, RV+ produces greater worries and dysfunctions in child behaviour.

[Clinicoepidemiological characteristics of community-acquired pneumonia in children aged less than 6 years old]. / Características clínico-epidemiológicas de la neumonía adquirida en la comunidad en niños menores de 6 años.

INTRODUCTION: Acute respiratory infections are an important cause of consultations in primary care and hospitals. Most published epidemiological studies have analyzed pneumonia in hospitals and very few include information on primary care. MATERIAL AND METHODS: We performed a multicenter, prospective, epidemiological study in 17 primary care centers and four hospital pediatric emergency rooms. All children under 6 years of age with a clinical diagnosis of pneumonia were included. RESULTS: There were 311 patients with a mean age of 32.2 months. The incidence of community-acquired pneumonia was 3,600 cases/100,000 children/year under 6 years old in primary care centers. Of these, 136 were diagnosed in hospitals (43.7 %). The most common clinical signs and symptoms were fever (95.4 %), cough (94.4 %), tachypnea (58.2 %), and auscultation abnormalities (90.2 %). Antibiotic therapy was started in 298 patients (98 %). The most frequent antibiotic was amoxicillin-clavulanate (39.5 %), followed by cefuroxime (32.7 %) and clarithromycin (8.3 %). The most frequently isolated microorganism was respiratory syncytial virus followed by Streptococcus pneumoniae. Hospital admission was required in 15.6 % of patients. Only 24.6 % of the patients had been vaccinated with the heptavalent pneumococcal conjugate vaccine and 12.7 % of the children with underlying respiratory diseases had been vaccinated with the influenza virus vaccine. CONCLUSIONS: In our milieu, the diagnosis and treatment of community-acquired pneumonia is usually carried out in primary care and the incidence is high. Although most patients do not require hospitalization, etiological diagnosis of community-acquired pneumonia and optimal antibiotic therapy remain difficult goals to achieve.

Características clínico-epidemiológicas de la neumonía adquirida en la comunidad en niños menores de 6 años / Clinicoepidemiological characteristics of community-acquired pneumonia in children aged less than 6 years old

Introducción. Las infecciones respiratorias agudas representan una importante causa de consulta a nivel de atención primaria y hospitalaria. La mayoría de estudios epidemiológicos publicados analizan las neumonías a nivel hospitalario, siendo escasos los que incluyen el nivel de atención primaria. Material y métodos. Estudio epidemiológico, prospectivo y multicéntrico realizado en Centros de Atención Primaria y Servicios de Urgencia Hospitalaria Pediátrica. Se han incluido en el estudio todos los niños menores de 6 años con diagnóstico clínico de neumonía. Resultados. Se incluyeron 311 pacientes con una media de edad de 32,2 meses. La incidencia de neumonía adquirida en la comunidad (NAC) fue de 3.600 casos/100.000 niños/año en menores de 6 años en centros de atención primaria. De los casos, 136 fueron diagnosticados en el hospital (43,7 %). Los síntomas y signos clínicos más comunes fueron: fiebre (95,4 %), tos (94,4 %), taquipnea (58,2 %) y alteraciones en la auscultación (90,2 %). Se instauró tratamiento antibiótico en 298 pacientes (98 %). La amoxicilina-ácido clavulánico fue el antibiótico más utilizado (39,5 %), seguido de cefuroxima (32,7 %) y claritromicina (8,3 %). El microorganismo más frecuentemente aislado fue el virus respiratorio sincitial seguido de Streptococcus pneumoniae. Requirieron ingreso hospitalario el 15,6 % de los casos. Solamente un 24,6 % de los niños menores de 2 años estaban vacunados con la vacuna antineumocócica conjugada heptavalente y un 12,7 % de niños con patología respiratoria de base estaban vacunados frente al virus de la gripe. Conclusiones. En nuestro medio, el diagnóstico y tratamiento de las neumonías adquiridas en la comunidad se realiza en el ámbito de atención primaria en la mayoría de los casos, presentando una alta tasa de incidencia. Aunque la mayoría de los casos no precisan atención hospitalaria, el diagnóstico etiológico de la NAC y la optimización del tratamiento antibiótico continúa siendo todavía un reto difícil de alcanzar

Introduction. Acute respiratory infections are an important cause of consultations in primary care and hospitals. Most published epidemiological studies have analyzed pneumonia in hospitals and very few include information on primary care. Material and methods. We performed a multicenter, prospective, epidemiological study in 17 primary care centers and four hospital pediatric emergency rooms. All children under 6 years of age with a clinical diagnosis of pneumonia were included. Results. There were 311 patients with a mean age of 32.2 months. The incidence of community-acquired pneumonia was 3,600 cases/100,000 children/year under 6 years old in primary care centers. Of these, 136 were diagnosed in hospitals (43.7 %). The most common clinical signs and symptoms were fever (95.4 %), cough (94.4 %), tachypnea (58.2 %), and auscultation abnormalities (90.2 %). Antibiotic therapy was started in 298 patients (98 %). The most frequent antibiotic was amoxicillin-clavulanate (39.5 %), followed by cefuroxime (32.7 %) and clarithromycin (8.3 %). The most frequently isolated microorganism was respiratory syncytial virus followed by Streptococcus pneumoniae. Hospital admission was required in 15.6 % of patients. Only 24.6 % of the patients had been vaccinated with the heptavalent pneumococcal conjugate vaccine and 12.7 % of the children with underlying respiratory diseases had been vaccinated with the influenza virus vaccine. Conclusions. In our milieu, the diagnosis and treatment of community-acquired pneumonia is usually carried out in primary care and the incidence is high. Although most patients do not require hospitalization, etiological diagnosis of community-acquired pneumonia and optimal antibiotic therapy remain difficult goals to achieve

Randomized comparison of dexamethasone combined with melphalan versus melphalan with prednisone in the treatment of elderly patients with multiple myeloma.

Melphalan-prednisone (MP) has been the gold standard treatment for more than 30 years in elderly multiple myeloma (MM) patients. In order to assess whether the combination of dexamethasone with melphalan (MD) could improve on the efficacy of MP, we have carried out a randomized trial comparing both treatment approaches. A total of 201 patients >/=70 years old were included in the study. The overall response rate was similar after six cycles (MP: 67.9%versus MD: 64.5%) and after 12 cycles (MP: 49.4%versus MD: 46.1%). However, the proportion of complete responses (CR) was higher in the MD arm, particularly after 12 cycles (MD: 22.4%versus MP: 9.1%; P < 0.05). There was no significant difference in event-free survival (MP: 15.9 months versus MD: 23.3 months). The median overall survival in both arms was almost identical (MP: 29.4 months versus MD: 27.2 months; P = 0.63). No significant differences in haematological toxicity were observed, but non-haematological toxicity was significantly higher in the MD arm. According to these results MP remains as the gold standard for treatment of MM and should be the reference for comparison of new therapeutic approaches involving novel agents.

[Anophthalmia as an isolated congenital defect]. / Anoftalmía como defecto congénito aislado.

CASE REPORT: We present the case of a newborn male whose only anomaly was an anophthalmia in his left eye. Complementary explorations were carried out to discard associated systemic pathologies. DISCUSSION: Anophthalmia/microphthalmia is the most frequent congenital eye malformation in the newborn. Its prevalence in Spain for the past twenty years was 21.34/100,000 newborn. The most usual presentation is as part of syndromes, appearing only exceptionally in an isolated way. It is important for the ophthalmologist to be aware of this pathology since the early treatment, because the corresponding orbital prosthesis may help to avoid, at least in part, dysmorphogenesis and derived aesthetic problems.

Anoftalmía como defecto congénito aislado / Anophthalmia as an isolated congenital defect

Caso clínico: Presentamos el caso de un varón recién nacido cuya única anomalía fue una anoftalmía en ojo izquierdo. Se le realizaron exploraciones complementarias para descartar patologías sistémicas asociadas que resultaron normales. Discusión: La anoftalmía/microftalmía es el defecto congénito ocular más frecuente en el recién nacido. Su prevalencia en España en los últimos 20 años es de 21,34/100.000 recién nacidos. Este defecto se presenta habitualmente en la clínica formando parte de síndromes, siendo muy rara su presentación de forma aislada. Es importante para el oftalmólogo conocer esta patología puesto que el tratamiento precoz con implantes orbitarios ayuda a evitar en parte la dismorfogénesis y trata de paliar los problemas estéticos subsecuentes (AU)

[Functional stabilization versus orthopedic immobility in grade-I-II (mild) ankle sprain]. / Estabilización funcional frente a inmovilización ortopédica en el esguince de tobillo grado I-II (leve).

OBJECTIVE: To proof that functional treatment is better than the orthopedic one in the slight ankle sprain. DESIGN: Clinical trial. SETTING: A primary care center, a outpatient clinic and a teaching hospital in Malaga. PATIENTS: 80 patients treated in emergence room for ankle ligament injuries. They were systematically sampled, 40 in each group of treatment. INTERVENTIONS: Functional stabilization or elastic adhesive bandaging during 7 days without support. Immobilization after the acute phase permitting then the support. Orthopedic stabilization or subsequent ferule during 21 days, followed by ankle rehabilitation. MEASUREMENTS AND MAIN RESULTS: We compared the healing time, treatment acceptance, absent of work time and need of rehabilitation in both groups. Functional stability is more effective than the orthopedic one: 1.39 times better in terms of curing, 7 times in terms of personal hygiene, 4.25 times in terms of need of rest, 5.5 times better in terms of need of rehabilitation. CONCLUSIONS: We confirm the initial hypothesis of the advantage of the functional treatment.

[Epidemiological aspects of children of women with bicornuate uterus]. / Aspectos epidemiológicos de los hijos de mujeres con útero bicorne.

BACKGROUND: Most published papers on women with a bicornuate uterus analyze their fertility problems, as well as certain pregnancy complications. We have not found any epidemiological study on the infants of mothers with this uterine malformation. Only in some papers a reference is made about the relationship of maternal bicornuate uterus with congenital deformations and disruptions in their infants. PATIENTS AND METHODS: Using data from the Spanish Collaborative Study of Congenital Malformations (ECEMC), which has a case-control methodology, some characteristics in a series of 26,945 malformed infants, such as birth weight, sex, gestational age, umbilical cord length, placental weight and maternal age, were analyzed by separating infants of mothers with normal uterus and those of mothers with a bicornuate uterus. RESULTS: Results showed that women with a bicornuate uterus have more daughters than sons and an increased risk for intrauterine growth retardation and prematurity with respect to infants of mothers with a normal uterus. On the other hand, the risk of having an infant with congenital defects is higher for women with a bicornuate uterus than for those with a normal uterus. CONCLUSIONS: Pregnancies of women with a bicornuate uterus have to be considered at risk since they have more risk for complications and for having an infant with congenital defects, premature birth and with intrauterine growth retardation.

[Syndromes with neural tube defects: epidemiologic analysis in Spain]. / Síndromes con defectos del tubo neural: análisis epidemiológico en España.

OBJECTIVE: We present, from an epidemiological perspective, the analysis of syndromes which present neural tube defects (NTD). Although there are many epidemiological studies on NTD all over the world, most of them are on isolated NTD; that is, when the infant only has NTD as the only anomaly. PATIENTS AND METHODS: The methodology is based on the review of hospital records of infants with congenital anomalies. This permitted the analysis of the prevalence. RESULTS: The results show that the frequency of syndromes with NTD is 27.5 time higher among stillborn infants than among liveborn infants. Nevertheless, there are not many syndromes in which the NTD are present more or less frequently. In fact, only 1.93% of the total cases with syndromes presented NTD, with the majority (43.4%) with genetic etiology. We also analyze the specific types of syndromes with NTD.

[Prophylaxis with ciprofloxacin in postchemotherapy neutropenia in acute myeloid leukemia]. / Profilaxis con ciprofloxacino en la neutropenia posquimioterápica de la leucemia mieloide aguda.

BACKGROUND: Infection is the most frequent complication in patients with acute myeloid leukemia (AML) following chemotherapy. The new quinolones, among which ciprofloxacin may be found, seem to be effective in the prophylaxis of this complication. METHODS: Fifty consecutive episodes of neutropenia were studied in patients with AML who received prophylaxis with ciprofloxacin and these were compared with a historic control group of another 50 consecutive episodes of neutropenia in AML patients who did not receive antibiotic prophylaxis. The difference with regard to the prevalence of infection and the characteristics of the same were studied. RESULTS: Ciprofloxacin significantly decreased the number of febrile episodes following chemotherapy of induction or consolidation with respect to those who did not receive prophylaxis (68% versus 94%; p = 0.002). Likewise, the patients who received ciprofloxacin presented fewer bacteriologically documented infections (26% versus 50%; p = 0.023), bacteremias (10 versus 25, p = 0.03) and infections produced by Gram negative microorganisms (2 versus 13, p = 0.009). Ciprofloxacin led to disappearance of the infections produced by Pseudomonas aeruginosa. Delay in the development of infection was observed in patients who received ciprofloxacin (mean: 11 days, CI: 7-15 days) with respect to those who did not receive prophylaxis (mean: 6 days, CI: 4-6 days) (p = 0.0001). CONCLUSIONS: Ciprofloxacin is an effective antibiotic in the prevention of infection in episodes of neutropenia after induction or consolidation chemotherapy in patients with acute myeloid leukemia. Not only does it decrease the number of febrile episodes, bacteriologically documented infections, bacteremias and infections produced by Gram negative microorganisms, but it also delays the appearance of the febrile episodes.

Short rib-polydactyly syndrome (SRPS) with anencephaly and other central nervous system anomalies: a new type of SRPS or a more severe expression of a known SRPS entity?

We describe two patients with short rib-polydactyly syndrome (SRPS) from two unrelated Spanish families. These patients present clinical and radiological characteristics that overlap those of the different established types of SRPS. In addition, one patient had anencephaly and the other patient had severe brain abnormalities with a family history of an older sister with anencephaly, and a brother diagnosed with SRPS. This second family is interesting in that the two affected brothers present with different clinical and radiological findings; for example, one had ovoid tibiae and the other did not. This particular family shows that intrafamiliar variation is also observed within SRPS. It remains unsettled whether these cases might be considered a new type of SRPS or a variant of an established entity or whether the differences between the SRPS represent variability or heterogeneity. Molecular studies may answer this question in the near future.

[Resistance to antivitamins K]. / Resistencia a los antivitamínicos K.

Resistance to oral anticoagulant is a rare phenomenon. We report the case of a 32-year-old woman who required anticoagulation due to a deep venous thrombosis. She gradually developed resistance to acenocumarol and warfarin. Although the HPLC (high performance liquid chromatography) method proved satisfactory acenocumarol levels in plasma, therapeutic anticoagulation was not achieved. The mechanisms of resistance are discussed.