Seguimiento de resultados de Test de Antígenos en trabajadores del ámbito sanitario con infección activa por SARS-CoV-2 / Monitoring of Antigen Test results in healthcare workers with active SARS-CoV-2 infection

Introducción: La introducción del Test de Antígenos como prueba válida para valorar el alta de un trabajador del ámbito sanitario afectado por SARS-CoV-2, supone un cambio importante para los Servicios de Prevención de centros sanitarios, por lo que se decide el estudio de los resultados obtenidos de dichas pruebas, en un hospital de la Comunidad de Madrid durante un tiempo determinado en un periodo de alta transmisibilidad, valorando el tiempo que tarda un trabajador con infección activa por SARS-CoV-2 en negativizar un Test de Antígenos. Método: Estudio observacional, descriptivo, retrospectivo realizado en el Hospital Universitario Infanta Cristina en Parla (Madrid) desde el 11 de enero del 2.022 hasta el 21 de febrero 2.022, en el que se estudian variables como sexo, edad, vacunación, categoría profesional e infección previa por SARS-CoV-2 y su influencia en el tiempo de negativización de un Test de Antígenos. Resultados: Un total de 164 trabajadores del ámbito sanitario se vieron afectados por Covid-19 durante el periodo estudiado, de los cuales 74 (45,1%) dieron positivo en Test de Antígenos a los 7 días del inicio de la infección, llegando hasta el 13º día 4 trabajadores (2,4 %). Conclusiones: Se pone de manifiesto que el haber tenido una infección previa por Covid-19, influye en el tiempo que tarda en negativizar un Test de Antígenos; disminuyéndolo, en trabajadores con infección activa por SARS-CoV-2 (AU)

Introduction: The introduction of the Antigen Test as a valid test to assess the discharge of a healthcare worker affected by SARS-CoV-2, represents an important change for the Prevention Services of health centers, for which it is decided to study the results obtained from these tests, in a hospital in the Community of Madrid for a certain time in a period of high transmissibility, assessing the time it takes for a worker with active SARS-CoV-2 infection to make an Antigen Test negative. Method: Observational, descriptive, retrospective study carried out at the Infanta Cristina University Hospital in Parla (Madrid) from January 11, 2022 to February 21, 2022, in which variables such as sex, age, vaccination, category professional and previous SARS-CoV-2 infection and its influence on the negative time of an Antigen Test. Results: A total of 164 healthcare workers were affected by Covid-19 during the period studied, of which 74 (45,1%) tested positive for Antigen Test 7 days after the start of the infection, reaching up to the 13th day 4 workers (2.4%). Conclusions: It is shown that having had a previous Covid-19 infection influences the time it takes for an Antigen Test to become negative; decreasing it, in health workers with active SARS-CoV-2 infection (AU)

Early markers of endocrinometabolic disease in newborns with delayed intrauterine growth.

INTRODUCTION: The adjustments to malnutrition in growth restricted fetus (GRF) that lead to obesity, insulin resistance, diabetes and cardiovascular disease in adulthood are not well known. The most feasible explanation for this association is the hypothesis of catch up. Some studies postulate a greater influence of catch up growth than the low birth weight itself in developing metabolic and cardiovascular disease. MATERIAL AND METHODS: This is a prospective cohort study of newborns with intrauterine growth restriction (defined as weight percentile at birth less than 10th) born during a one-year period. Clinical data of patients were recorded (gender, gestational age, data about breastfeeding and anthropometry during follow-up every 3 months). Some details of pregnancy and characteristics of the mother were also registered. Serum biochemical parameters (IGF-1, IGF-BP3, insulin, glucose, total cholesterol, HDL cholesterol, DLD cholesterol, triglycerides, HOMA) were collected at birth from cord blood, 9 and 12 months. Two main comparative groups were established: those GRF who made a catch-up growth (increase in weight Z score higher than 0,67) during the follow-up and those who did not get it. RESULTS: 126 GRF children were born in the study period. 125 accepted the inclusion in the study and 67 of them completed the full monitoring for a year; 47 of them made recovery growth and 20 did not. A significant difference between both groups was found in glucose in umbilical cord and triglycerides at 12 months: GRF children with catch up growth showed lower glucose levels (p = 0.03) and higher levels of triglycerides (p = 0.03). There were no statistically significant differences in the rest of laboratory parameters analyzed (IGF-1, IGF-BP3, insulin, glucose, total cholesterol, HDL cholesterol, DLD cholesterol, HOMA at 9 and 12 months or triglycerides at 9 months). CONCLUSIONS: Those GRF with catch up growth during the first year of life have early changes in the triglycerides at the end of that period with higher levels than those GRF children without catch up growth. This finding could be useful to develop a tool for early detection of GRF children with higher metabolic risk in order to prevent future pathology.

[Wolf-Hirschhorn syndrome. Description of a Spanish cohort of 51 cases and a literature review]. / Sindrome de Wolf-Hirschhorn. Descripcion de una cohorte española de 51 casos y revision de la bibliografia.

INTRODUCTION: Wolf-Hirschhorn syndrome (WHS) is a contiguous gene syndrome that gives rise to multiple congenital anomalies, caused by the loss of a distal portion of the short arm of chromosome 4 (4p16.3). It is characterised by its own peculiar facial phenotype, associated to growth problems, psychomotor retardation and epilepsy. AIMS: To establish a register of patients with WHS in Spain, describe their characteristics, determine the prevalence of epilepsy, estimate the degree of psychomotor retardation and perform a review of the literature in order to compare these data with those published to date. PATIENTS AND METHODS: In collaboration with the Spanish Wolf-Hirschhorn Syndrome Association, we contacted the families affected and collected data via forms endorsed by medical reports. RESULTS: The characteristics of 51 patients are described. Psychomotor retardation was considered the most severe in 37% of cases. Of the total sample, 88% presented epilepsy, and nearly all of them showed growth problems. The mean size of the deletion was 8.4 Mb, and the phenotype is displayed in photographs. Other clinical features reported were sensory alterations and nephrourological and cardiological pathologies. CONCLUSIONS: This study reports on the second largest cohort of patients with WHS with a genetic characterisation published to date. Many of the characteristics coincide with those described previously, with several exceptions, such as the degree of psychomotor retardation, which appears to be lower in the sample studied here.

TITLE: Sindrome de Wolf-Hirschhorn. Descripcion de una cohorte española de 51 casos y revision de la bibliografia.Introduccion. El sindrome de Wolf-Hirschhorn (SWH) es un sindrome de genes contiguos que provoca multiples anomalias congenitas, causado por la perdida de una porcion distal del brazo corto del cromosoma 4 (4p16.3). Se caracteriza por un fenotipo facial peculiar propio, asociado a problemas de crecimiento, retraso psicomotor y epilepsia. Objetivos. Realizar un registro de pacientes con SWH en España, describir sus caracteristicas, conocer la prevalencia de epilepsia, estimar el grado de retraso psicomotor y realizar una revision de la bibliografia para comparar estos datos con lo publicado hasta la fecha. Pacientes y metodos. En colaboracion con la Asociacion Española de Sindrome de Wolf-Hirschhorn se contacto con las familias afectadas y se realizo una recogida de datos mediante formularios corroborados por informes medicos. Resultados. Se describen las caracteristicas de 51 pacientes. El retraso psicomotor fue considerado grave en el 37% de los casos. El 88% presentaba epilepsia, y la practica totalidad, problemas de crecimiento. El tamaño medio de la delecion fue de 8,4 Mb y el fenotipo se expone en fotografias. Otra clinica descrita fueron alteraciones sensoriales y patologia nefrourologica y cardiologica. Conclusiones. Se describe la segunda cohorte en tamaño de pacientes con SWH publicada hasta la fecha con caracterizacion genetica. Muchas de las caracteristicas coinciden con lo ya descrito, salvo algunas, como el grado de retraso psicomotor, que parece ser menor en la muestra estudiada.

Retrospective multicentre observational study on clinical management and treatment of different types of status epilepticus in clinical practice. / Estudio observacional multicéntrico retrospectivo sobre el manejo clínico y terapéutico de los diferentes tipos de estatus epiléptico en la práctica clínica.

INTRODUCTION: Status epilepticus (SE) is a neurological emergency associated with significant mortality and morbidity. We analyse characteristics of this entity in our population. METHODS: Data from electronic medical records of adults diagnosed with SE were collected retrospectively from 5 hospitals over 4 years. RESULTS: Data reflected 84 episodes of SE in 77 patients with a mean age of 60.3 years. Of this sample, 52.4% had a previous history of epilepsy. Status classification: 47.6% tonic-clonic, 21.4% complex partial, 17.9% partial motor, 6% partial simple, 3.6% myoclonic, and 3.6% subtle SE. Based on the duration of the episode, SE was defined in this study as early stage (up to 30min) in 13.1%, established (30-120min) in 20.2%, refractory (more than 120min) in 41.7%, and super-refractory (episodes continuing or recurring after more than 24h of anaesthesia) in 13.1%. Ten patients (11.9%) died when treatment failed to control SE. The cumulative percentage of success achieved was 8.3% with the first treatment, 27.3% for the second, 48.7% for the third, 58.2% for the fourth, 70.1% for the fifth, 80.8% for the sixth, 83.2% for the seventh, and 84.4% for the eighth. CONCLUSIONS: In our study, we found that SE did not respond to treatment within 2h in approximately half the cases and 11.9% of the patients died without achieving seizure control, regardless of the type of status. Half the patients responded by the third treatment but some patients needed as many as 8 treatments to resolve seizures. Using large registers permitting analysis of the different types and stages of SE is warranted.

[Current situation of the demand for health care in neuropaediatrics. Characteristics of consultations and comparison with other paediatric specialties]. / Situacion actual de la demanda asistencial en neuropediatria. Caracteristicas de la consulta y comparacion con otras especialidades pediatricas.

INTRODUCTION: In recent years it seems we are witnessing an increasing demand for neuropaediatric care. Epidemiological studies are needed to make this demand more widely known and thus promote appropriate management of health care resources. AIMS: To determine what proportion of all visits to the paediatric department in our hospital are neuropaediatric consultations, the annual consultation rate in child neurology per 1,000 inhabitants under 14 years of age, and the characteristics of that consultation (demographic data, reasons for the visit and others). PATIENTS AND METHODS: We conducted a retrospective, descriptive study on the health care activity of paediatric and neuropaediatric units in a level-II public hospital in the south of Madrid, over the period 2008-2012. RESULTS: Since our centre opened, the number of paediatric consultations has increased sharply, neuropaediatric visits being the most frequently demanded. In the year 2012 a total of 2,129 patients were seen (718 first visits), with a successive/first visit index of 1.96. Of all the paediatric consultations carried out in the hospital, 23.49% took place in neuropaediatrics. The mean rate of first visits in the period under study was 72.86/1,000 children. The main reasons for the consultation were learning disabilities/conduct disorders (24.1%), followed by headaches (21.9%), paroxysmal episodes (14.8%) and delayed psychomotor development (9%). CONCLUSIONS: The increase in demand for neuropaediatrics health care was clearly higher than that of other paediatric specialities over the same period of time. In the five years included in the study, the rate of first visits increased threefold. This health care overload could condition the care dispensed to patients with severe neurological pathologies. Further studies of a similar nature in different regions are required to determine the real situation of neuropaediatrics in Spain.

TITLE: Situacion actual de la demanda asistencial en neuropediatria. Caracteristicas de la consulta y comparacion con otras especialidades pediatricas.Introduccion. En los ultimos años parecemos asistir a una creciente demanda asistencial en neuropediatria. Los estudios epidemiologicos son necesarios para dar a conocer dicha demanda y asi favorecer una adecuada gestion de los recursos sanitarios. Objetivo. Conocer el peso proporcional de las consultas de neuropediatria en el global de las consultas pediatricas en nuestro hospital, la tasa anual de consulta en neurologia infantil por cada 1.000 habitantes menores de 14 años y las caracteristicas de dicha consulta (datos demograficos, motivos de consulta y otras). Pacientes y metodos. Estudio retrospectivo, descriptivo, sobre la actividad asistencial de consultas pediatricas y neuropediatricas en un hospital publico de nivel II en el sur de Madrid, durante el periodo 2008-2012. Resultados. Desde la apertura de nuestro centro, las consultas de pediatria han experimentado un marcado crecimiento, siendo las de neuropediatria las mas demandadas, ya que en el año 2012 atendieron a un total de 2.129 pacientes (718 primeras consultas), con un indice de sucesiva/primera consulta de 1,96. En neuropediatria, se atendieron el 23,49% de todas las consultas pediatricas realizadas en el hospital. La tasa media de primeras consultas en el periodo de estudio fue de 72,86/1.000 niños. Los principales motivos de consulta fueron los problemas de aprendizaje/trastornos de conducta (24,1%), seguidos de cefalea (21,9%), episodios paroxisticos (14,8%) y retraso del desarrollo psicomotor (9%). Conclusiones. El incremento en la demanda asistencial de la neuropediatria ha resultado claramente superior al de las otras especialidades pediatricas que llevan en funcionamiento el mismo periodo. En los cinco años de estudio, la tasa de primeras visitas se ha triplicado. Esta sobrecarga asistencial podria condicionar la atencion a los pacientes con patologia neurologica grave. Serian necesarios estudios similares en diferentes regiones para conocer la realidad de la neuropediatria española.

Consumo de alcohol y riesgo cardiovascular / Alcohol consumption and cardiovascular risk

Existe controversia sobre los efectos del consumo de bebidas alcohólicas en las enfermedades cardiovasculares. El objetivo de este trabajo es revisar las evidencias publicadas, diferenciando estudios epidemiológicos y experimentales. Los estudios ecológicos han demostrado un leve efecto protector con el consumo moderado de bebidas alcohólicas, mientras que en los estudios controlados se encuentra un efecto en 'J', con reducciones de riesgo en dosis bajas de alcohol y aumento de riesgo a mayores dosis. El consumo recomendable de alcohol es de unos 50 g/día en varones y 30 g/día en mujeres. Los estudios epidemiológicos no aclaran si este efecto beneficioso se debe al propio alcohol u otros componentes que explicarían distintos efectos entre diversas bebidas alcohólicas. Los estudios experimentales arrojan resultados distintos. Parte de las discrepancias podría deberse a diferencias genéricas entre las poblaciones estudiadas pero existen muchas dudas sobre la comparabilidad de los resultados, ya que las bebidas empleadas en las investigaciones presentan composiciones químicas diferentes. Existen razonables evidencias que apuntan a un efecto protector del vino que se ha relacionado con la presencia de polifenoles, que poseen un poderoso efecto antioxidante. Sin embargo, las diferencias en los efectos de estas sustancias y la complejidad química derivada de los procesos de producción de cada vino hacen poco comparables los resultados. A pesar de estos datos, hay que ser prudentes en el mensaje que se transmite a la población sobre el efecto beneficioso de las bebidas alcohólicas, ya que sólo parecen beneficiarse las personas que posean factores de riesgo cardiovascular (AU)