Immunogenicity and safety of a quadrivalent meningococcal tetanus toxoid-conjugate vaccine (MenACYW-TT) vs. a licensed quadrivalent meningococcal tetanus toxoid-conjugate vaccine in meningococcal vaccine-naïve and meningococcal C conjugate vaccine-primed toddlers: a phase III randomised study.

Vaccination remains the best strategy to reduce invasive meningococcal disease. This study evaluated an investigational tetanus toxoid-conjugate quadrivalent meningococcal vaccine (MenACYW-TT) vs. a licensed tetanus toxoid-conjugate quadrivalent meningococcal vaccine (MCV4-TT) (NCT02955797). Healthy toddlers aged 12-23 months were included if they were either meningococcal vaccine-naïve or MenC conjugate (MCC) vaccine-primed (≥1 dose of MCC prior to 12 months of age). Vaccine-naïve participants were randomised 1:1 to either MenACYW-TT (n = 306) or MCV4-TT (n = 306). MCC-primed participants were randomised 2:1 to MenACYW-TT (n = 203) or MCV4-TT (n = 103). Antibody titres against each of the four meningococcal serogroups were measured by serum bactericidal antibody assay using the human complement. The co-primary objectives of this study were to demonstrate the non-inferiority of MenACYW-TT to MCV4-TT in terms of seroprotection (titres ≥1:8) at Day 30 in both vaccine-naïve and all participants (vaccine-naïve and MCC-primed groups pooled). The immune response for all four serogroups to MenACYW-TT was non-inferior to MCV4-TT in vaccine-naïve participants (seroprotection: range 83.6-99.3% and 81.4-91.6%, respectively) and all participants (seroprotection: range 83.6-99.3% and 81.4-98.0%, respectively). The safety profiles of both vaccines were comparable. MenACYW-TT was well-tolerated and demonstrated non-inferior immunogenicity when administered to MCC vaccine-primed and vaccine-naïve toddlers.

Salud mental en Atención Primaria: Recomendaciones para el abordaje de los trastornos más prevalentes

Incluye: episodio depresivo, trastornos de ansiedad, trastornos de adaptación, trastorno somatomorfo, psicoterapia de apoyo, antidepresivos: tabla y generalidades de uso, ansiolíticos: tabla y generalidades de uso, escala de ansiedad y depresión de Goldberg, abordaje del insomnio, abordaje del suicidio.

Repercusión de la infección de vía respiratoria alta en niños sobre la programación quirúrgica en un hospital infantil / Upper respiratory tract infections in children: impact on surgical scheduling at a pediatric hospital

OBJETIVO: Detectar la incidencia de suspensiones de intervenciones quirúrgicas programadas por infección de vía respiratoria superior (IRA) en nuestro medio y analizar la repercusión sobre estas suspensiones de la instauración de un protocolo basado en sucesivas revisiones bibliográficas y en una adecuada información a los padres. MATERIAL Y MÉTODOS: Estudiamos de manera retrospectiva las causas de suspensión de las intervenciones quirúrgicas programadas del quirófano de otorrinolaringología pediátrica (ORL) durante los años 2001, 2002, 2003 y 2004. El estudio estadístico se realizó utilizando el test estadístico del Chi cuadrado. RESULTADOS: En el periodo de estudio del 2001 se suspendieron el 24% de los 641 pacientes programados, suspendiéndose por IRA el 12,9%. Tras la instauración del protocolo, en el 2002 se suspendieron el 15% de los 751 pacientes programados, suspendiéndose por IRA el 4,9% (p<0,0001 respecto al 2001). En el 2003 se suspendieron el 14,3% de los 760 pacientes programados, suspendiéndose por IRA el 6,5% (p<0,0001 respecto al 2001). En el 2004 se suspendieron el 12,2% de los 692 pacientes programados, suspendiéndose por IRA el 7,2% (p<0,0001 respecto al 2001). Durante los meses de otoño-invierno / primavera- verano se suspendieron el 28,2% /19,8% en el 2001, 17,1% /12,7% en el 2002, 16,6% /11,8% en el 2003 y 13,8% /11,1% en el 2004. CONCLUSIONES: La IRA provoca una alta tasa de suspensiones de intervenciones quirúrgicas programadas, sobre todo en estaciones frías. Para optimizar los resultados es necesario disponer de protocolos de actuación basados en sucesivas revisiones bibliográficas y en una adecuada información a los padres

OBJECTIVE: To determine the rate of cancelation of scheduled surgical procedures attributable to upper respiratory tract infection (URTI) in our university pediatric hospital in Madrid and to analyze the effect that literature reviews and appropriate counseling of parents would have on cancelations. MATERIAL AND METHODS:We carried out a retrospective study of the reasons for canceling scheduled pediatric ear, nose, or throat operations in 2001, 2002, 2003, and 2004. Statistical comparisons were performed with the chi2 test. RESULTS: In 2001, 24% of the 641 procedures scheduled were canceled, 12.9% of them because of URTIs. After applying criteria based on a review of the literature, 15% of the 751 procedures were canceled in 2002, 4.9% of them because of URTIs (P<0.0001 in comparison with 2001). In 2003 14.3% of the 760 scheduled procedures were canceled, 6.5% because of URTIs (P<0.0001 in the comparison with 2001). In 2004 12.2% of the 692 scheduled procedures were canceled, 7.2% because of URTIs (P<0.0001 in comparison with 2001). Cancelations in autumn–winter or in spring–summer seasons amounted to 28.2% vs 19.8% in 2001, 17.1% vs 12.7% in 2002, 16.6% vs 11.8% in 2003, and 13.8% vs 11.1% in 2004. CONCLUSIONS: URTIs are responsible for a high rate of cancelations of scheduled operations, particularly in colder seasons of the year. To obtain optimal results, criteria based on up-to-date literature reviews should be put into effect and parents should be given appropriate information

[Upper respiratory tract infections in children: impact on surgical scheduling at a pediatric hospital]. / Repercusión de la infección de vía respiratoria alta en niños sobre la programación quirúrgica en un hospital infantil.

OBJECTIVE: To determine the rate of cancelation of scheduled surgical procedures attributable to upper respiratory tract infection (URTI) in our university pediatric hospital in Madrid and to analyze the effect that literature reviews and appropriate counseling of parents would have on cancelations. MATERIAL AND METHODS: We carried out a retrospective study of the reasons for canceling scheduled pediatric ear, nose, or throat operations in 2001, 2002, 2003, and 2004. Statistical comparisons were performed with the chi2 test. RESULTS: In 2001, 24% of the 641 procedures scheduled were canceled, 12.9% of them because of URTIs. After applying criteria based on a review of the literature, 15% of the 751 procedures were canceled in 2002, 4.9% of them because of URTIs (P<0.0001 in comparison with 2001). In 2003 14.3% of the 760 scheduled procedures were canceled, 6.5% because of URTIs (P<0.0001 in the comparison with 2001). In 2004 12.2% of the 692 scheduled procedures were canceled, 7.2% because of URTIs (P<0.0001 in comparison with 2001). Cancelations in autumn-winter or in spring-summer seasons amounted to 28.2% vs 19.8% in 2001, 17.1% vs 12.7% in 2002, 16.6% vs 11.8% in 2003, and 13.8% vs 11.1% in 2004. CONCLUSIONS: URTIs are responsible for a high rate of cancelations of scheduled operations, particularly in colder seasons of the year. To obtain optimal results, criteria based on up-to-date literature reviews should be put into effect and parents should be given appropriate information.

Sturge-Weber syndrome: study of 40 patients.

Forty patients with Sturge-Weber syndrome were studied over a 26-year period. The nevus flammeus was unilateral in 27 patients (twice as often on left side) and bilateral in 13 patients. Only 3 of these 13 patients had bilateral cerebral lesions. Seizures, most of which were focal, were present in 32 patients (80%). The percentage of patients in whom the seizures subsequently became generalized was very high. Seizure presentation coincided with febrile episodes in 10 of 32 patients (31%). Total seizure control was obtained in 15 patients (47%). Abnormality of the cerebral parenchyma can be detected from birth in some patients and has a progressive character; at the same time, progressive atrophy and parenchymatous hyperdensity of the affected hemisphere is evident, as well as a decrease in arterial size, especially during the first decade of life. No relationship exists between the size of the facial nevus flammeus or its unilateral or bilateral location and clinical neurologic impairment. Conversely, a direct relationship exists between greater anatomic manifestations (i.e., atrophy, calcification) in the involved hemisphere when the lesion is unilateral as well as the presence of leptomeningeal angiomatosis in both cerebral hemispheres in patients with bilateral facial nevus flammeus and the severity of clinical disorders. Mental retardation was present in 60% of patients and was severe in 32.5% of all patients. Even though computed tomography and T1- and T2-weighted magnetic resonance imaging have great diagnostic value, magnetic resonance imaging enhanced with gadolinium-DTPA discloses the cerebral, leptomeningeal, and ocular lesions before the first evidence of neurologic abnormality.(ABSTRACT TRUNCATED AT 250 WORDS)