Síndrome de Dress: reacción alérgica tras la colocación de un catéter peritoneal / Dress syndrome: allergic reaction after placement of a peritoneal catheter

CASO CLÍNICO: Paciente que inició un Síndrome de Dress tras la colocación del catéter peritoneal. En la literatura se han reportado un número muy escaso de casos de reacción alérgica al catéter peritoneal e inicialmente se sospechó como causa un antibiótico profiláctico utilizado en el quirófano, pero tras sufrir en su domicilio una exacerbación de la sintomatología a la semana de la implantación, se planteó la posibilidad de que el catéter fuera el origen del cuadro, por lo que el paciente ingresó para monitorización y administración de medicación con una mejoría clínica significativa. El Plan de Cuidados se centraba en la resolución aguda del proceso alérgico y asistir al paciente en la técnica hasta que pudo realizarla autónomamente. Finalmente, el cuadro clínico se atribuyó a un Síndrome de Dress provocado por alopurinol. CONCLUSIONES: Tras una revisión bibliográfica y ante la falta de evidencia, se decidió no retirar el catéter y tratar el cuadro, que se solucionó, pudiendo iniciar el paciente la técnica en domicilio de forma autónoma

CLINICAL CASE: Patient suffering from Dress Syndrome after placement of the peritoneal catheter. A very few cases of allergic reaction to the peritoneal catheter have been reported in the literature. Initially, the use of a prophylactic antibiotic used in the operating room was suspected as a cause, but after suffering an exacerbation of symptoms one week after implantation at the patient's home, the possibility that the catheter was the origin of the condition was raised. Then, the patient was admitted for monitoring and administration of medication with significant clinical improvement. The care plan was focused on the acute resolution of the allergic process and on assisting the technique until the patient was able to perform it autonomously. Finally, the clinical picture was attributed to a Dress Syndrome caused by allopurinol. CONCLUSIONS: After a bibliographic review and in the absence of evidence, it was decided not to remove the catheter and treat the clinical picture, which was resolved, and the patient could start the technique at home autonomously

Protocolo de seguimiento de los pacientes con displasia broncopulmonar / Guidelines for the follow up of patients with bronchopulmonary dysplasia

La displasia broncopulmonar (DBP) es la secuela más prevalente del recién nacido pretérmino, y sigue suponiendo un motivo frecuente de consulta en las unidades de Neumología Pediátrica. La decisión del alta de la unidad neonatal debe apoyarse en una valoración exhaustiva de la situación clínica del paciente y en el cumplimiento de unos requisitos, que incluyen la estabilidad respiratoria y nutricional, y la instrucción a los cuidadores en el manejo domiciliario. Para un control adecuado de la enfermedad, es necesario que quede establecido, previamente al alta, un calendario de visitas y de exploraciones complementarias, y deben aplicarse las pautas de prevención de exacerbaciones y el tratamiento apropiados. El concepto de DBP como enfermedad multisistémica es fundamental en el seguimiento de los pacientes y debe ser tenido en cuenta para un buen control de la enfermedad. En este documento, el Grupo de Trabajo de Patología Respiratoria Perinatal de la Sociedad Española de Neumología Pediátrica propone un protocolo que sirva como referencia para unificar el seguimiento de los pacientes con DBP entre los diferentes centros y ámbitos asistenciales. Se revisan los aspectos a tener en cuenta en la evaluación previa al alta de la Unidad Neonatal y las principales complicaciones durante el seguimiento. Seguidamente, se detallan las recomendaciones en materia de tratamiento de la enfermedad y prevención de complicaciones, los controles tras el alta y su cronología

Bronchopulmonary dysplasia (BPD) is the most common complication of preterm birth, and remains a major problem in pediatric pulmonology units. The decision of discharging from the Neonatal Unit should be based on a thorough assessment of the condition of the patient and compliance with certain requirements, including respiratory and nutritional stability, and caregiver education on disease management. For proper control of the disease, a schedule of visits and complementary tests should be established prior to discharge, and guidelines for prevention of exacerbations and appropriate treatment should be applied. In this paper, the Working Group in Perinatal Respiratory Diseases of the Spanish Society of Pediatric Pulmonology proposes a protocol to serve as a reference for the follow up of patients with BPD among different centers and health care settings. Key factors to consider when planning discharge from the Neonatal Unit and during follow up are reviewed. Recommendations on treatment and prevention of complications are then discussed. The final section of this guide aims to provide a specific schedule for follow-up and diagnostic interventions to be performed in patients with BPD

[Guidelines for the follow up of patients with bronchopulmonary dysplasia]. / Protocolo de seguimiento de los pacientes con displasia broncopulmonar.

Bronchopulmonary dysplasia (BPD) is the most common complication of preterm birth, and remains a major problem in pediatric pulmonology units. The decision of discharging from the Neonatal Unit should be based on a thorough assessment of the condition of the patient and compliance with certain requirements, including respiratory and nutritional stability, and caregiver education on disease management. For proper control of the disease, a schedule of visits and complementary tests should be established prior to discharge, and guidelines for prevention of exacerbations and appropriate treatment should be applied. In this paper, the Working Group in Perinatal Respiratory Diseases of the Spanish Society of Pediatric Pulmonology proposes a protocol to serve as a reference for the follow up of patients with BPD among different centers and health care settings. Key factors to consider when planning discharge from the Neonatal Unit and during follow up are reviewed. Recommendations on treatment and prevention of complications are then discussed. The final section of this guide aims to provide a specific schedule for follow-up and diagnostic interventions to be performed in patients with BPD.

XV Congreso SEINAP. Influencia de los ácidos grasos en el neurodesarrollo de hijos de madres con diabetes gestacional / XV Congreso SEINAP. Influence of fatty acids in teh neurodevelopment of children of mothers with gestational diabetes

No disponible

Sensibilidad de Streptococcus pneumoniae en niños portadores sanos en Murcia (España) / Antibiotic susceptibility of Streptococcus pneumoniae in healthy carrier children in Murcia (Spain)

INTRODUCCIÓN Y OBJETIVOS: Streptococcus pneumoniae (SP) es un patógeno que causa un elevado consumo de antibióticos. OBJETIVOS: conocer la sensibilidad a antibióticos de uso habitual, los factores epidemiológicos asociados y favorecer el uso racional de antibióticos. PACIENTES Y MÉTODOS: En verano del 2009 y el invierno del 2010 realizamos un estudio multicéntrico en Atención Primaria (AP). Se recogió una muestra nasofaríngea y se cumplimentó una encuesta epidemiológica en 1.562 niños de 1 y 4 años. RESULTADOS: El 31,3% (489/1.562) eran portadores nasales (PN). Se realizó un estudio de sensibilidad en 376 aislados, y se serotipificaron 343. El 61,7% (964/1.562) habían recibido al menos una dosis de vacuna antineumocócica conjugada heptavalente (PCV7). El 12,8% (44/343) correspondía a serotipos vacunales (SV). La resistencia a penicilina (criterio meningitis CMI>0,06mg/l) fue del 28%, siendo del 54% para los SV. Para infecciones no meníngeas, el 100% de los aislados eran sensibles a penicilina parenteral (CMI ≤ 2mg/l). Existe un alto nivel de resistencias para eritromicina (45,8%). Fueron factores favorecedores de resistencia haber tomado antibióticos el mes previo y ser portador de SV tanto para penicilina como para cefotaxima y la edad de 4 años un factor de protección. Los serotipos 14, 35B, 19A, 15A y 19F fueron los menos susceptibles a penicilina. CONCLUSIONES: La amoxicilina por vía oral para pacientes ambulatorios y la penicilina o ampicilina por vía intravenosa para pacientes ingresados son excelentes opciones para el tratamiento de infecciones neumocócicas no meníngeas, en entornos como el nuestro, con una baja incidencia de aislados con alto nivel de resistencia a penicilina (CMI ≥ 2mg/l)

INTRODUCTION AND OBJECTIVES: Streptococcus pneumoniae (SP) is a human pathogen that involves a high use of antibiotics. The objective of the study was to determine the susceptibility to commonly used antibiotics and their associated risk factors, in order to promote rational use of antibiotics. PATIENTS AND METHODS: In A multicentre study was conducted in summer 2009 and winter 2010 on children attending paediatric clinics in the Region of Murcia. A nasopharyngeal sample was collected and an epidemiological questionnaire was completed. The study included 1562 children aged 1 and 4 years old. RESULTS: Almost one-third (31.3%, 489/1562) of children were nasal carriers. A sensitivity study was carried out on 376 isolates, of which 343 were serotyped. Almost two-thirds (61.7%, 964/1562) of children had received at least one dose of PCV7 heptavalent pneumococcal conjugate vaccine), and 12.8% (44/343) of the isolates belonged to PCV7 serotypes. The prevalence rates of penicillin resistance (meningitis infections criteria CMI>0.06mg/L) were 28.1%; however, this percentage was 54% in PCV7 serotypes. None of the isolates had (MIC >2mg/L), so prevalence rates of susceptibility with non-meningitis infections criteria were 100%. There was a high percentage of erythromycin resistance (45.7%). The factors favouring resistance to penicillin and cefotaxime were the consumption of antibiotics in the previous month and the carrying of vaccine serotypes. On the other hand, the age of 4 years old was a protective factor of resistance. The 14, 35B, 19A, 15A, and 19F serotypes were less susceptible to penicillin. CONCLUSIONS: Both oral amoxicillin given to outpatients and intravenous penicillin or ampicillin to hospitalized patients are excellent options for the treatment of non-meningeal infections, as seen with pneumonia in these kinds of environments, where there is low incidence of isolates highly resistant to penicillin (CMI ≥ 2mg/L)

[Antibiotic susceptibility of Streptococcus pneumoniae in healthy carrier children in Murcia (Spain)]. / Sensibilidad de Streptococcus pneumoniae en niños portadores sanos en Murcia (España).

INTRODUCTION AND OBJECTIVES: Streptococcus pneumoniae (SP) is a human pathogen that involves a high use of antibiotics. The objective of the study was to determine the susceptibility to commonly used antibiotics and their associated risk factors, in order to promote rational use of antibiotics. PATIENTS AND METHODS: In A multicentre study was conducted in summer 2009 and winter 2010 on children attending paediatric clinics in the Region of Murcia. A nasopharyngeal sample was collected and an epidemiological questionnaire was completed. The study included 1562 children aged 1 and 4 years old. RESULTS: Almost one-third (31.3%, 489/1562) of children were nasal carriers. A sensitivity study was carried out on 376 isolates, of which 343 were serotyped. Almost two-thirds (61.7%, 964/1562) of children had received at least one dose of PCV7 (heptavalent pneumococcal conjugate vaccine), and 12.8% (44/343) of the isolates belonged to PCV7 serotypes. The prevalence rates of penicillin resistance (meningitis infections criteria CMI>0.06mg/L) were 28.1%; however, this percentage was 54% in PCV7 serotypes. None of the isolates had (MIC >2mg/L), so prevalence rates of susceptibility with non-meningitis infections criteria were 100%. There was a high percentage of erythromycin resistance (45.7%). The factors favouring resistance to penicillin and cefotaxime were the consumption of antibiotics in the previous month and the carrying of vaccine serotypes. On the other hand, the age of 4 years old was a protective factor of resistance. The 14, 35B, 19A, 15A, and 19F serotypes were less susceptible to penicillin. CONCLUSIONS: Both oral amoxicillin given to outpatients and intravenous penicillin or ampicillin to hospitalized patients are excellent options for the treatment of non-meningeal infections, as seen with pneumonia in these kinds of environments, where there is low incidence of isolates highly resistant to penicillin (CMI ≥ 2mg/L).

Características epidemiológicas, clínicas y terapéuticas de lactantes hospitalizados por bronquiolitis / Epidemiology, clinical features and medical interventions in children hospitalized for bronchiolitis

Objetivos: Describir los datos epidemiológicos, clínicos y actitud terapéutica empleada en los lactantes hospitalizados por bronquiolitis en nuestro medio. Material y métodos: Estudio observacional, descriptivo y prospectivo de lactantes menores de 18 meses ingresados en Hospital Virgen de la Arrixaca (Murcia) con el diagnóstico de bronquiolitis, durante el periodo de máxima incidencia (diciembre 2008-abril 2009). Resultados: Ingresaron 235 lactantes, de los que el 78,7% tenía una edad menor o igual a 5 meses de vida. Había una correlación positiva entre el número de cigarrillos consumidos por la madre en la gestación y el número de días de oxigenoterapia y los días de estancia. Los niños cuya madre era fumadora en el momento de su ingreso fueron tratados con oxígeno un mayor número de días. Los lactantes que no habían recibido lactancia materna precisaron oxígeno durante más tiempo. El 23,8% tenía patología de base, siendo la prematuridad la más frecuente, la cual fue un factor de riesgo para la prolongación del tratamiento con oxígeno y de la estancia hospitalaria. La utilización de exploraciones complementarias y el uso de broncodilatadores, corticoides y antibióticos fueron elevados. La aparición de fiebre se asoció a un mayor uso de antibióticos en el medio extra e intrahospitalario y lo mismo sucedía si la radiografía de tórax era patológica o existía una elevación de la proteína C reactiva (PCR). El VRS fue el principal agente etiológico, seguido por rinovirus, bocavirus, adenovirus y metapneumovirus. Conclusiones: La mayoría de los ingresos por bronquiolitis ocurrieron en los primeros meses de la vida. La exposición al tabaco durante la gestación se asoció a una peor evolución clínica. A pesar de las indicaciones de las guías de práctica clínica, en nuestro medio, el uso de exploraciones complementarias y de tratamientos farmacológicos fue elevado(AU)

Objectives: To describe the epidemiology, clinical characteristics and treatments prescribed in children with bronchiolitis admitted to our hospital. Material and methods: Observational, descriptive and prospective study of children younger than 18 months, admitted to Hospital Virgen de la Arrixaca of Murcia (Spain), with the diagnosis of bronchiolitis, during the season of maximum incidence (December 2008-April 2009). Results: A total of 235 infants were admitted, of whom 78.7% of them were aged 5 months or less. We found a positive correlation between the number of cigarettes smoked by their mothers during pregnancy and the number of hospitalization and oxygen therapy days. Children whose mothers were smokers at the time of their admission needed a greater number of oxygen therapy days. Also infants who were not breastfed needed oxygen therapy during more days. Just under one quarter (23.8%) of them had underlying diseases, with prematurity being the most frequent and a risk factor for the ongoing of oxygen therapy and hospital stay. The use of diagnostic tests, bronchodilators, corticosteroids and antibiotics was high. The onset of high temperature was associated with an increased use of antibiotics in outside and inside the hospital setting. An abnormal chest X-ray or a raised C-reactive protein was associated with a higher use of antibiotics. Respiratory Syncytial virus (RSV) was the main aetiological agent, followed by Rhinovirus, Bocavirus, Adenovirus and Metapneumovirus. Conclusions: The majority of hospital admissions due to bronchiolitis took place during the first months of life. Infants whose mothers smoked during pregnancy had a worse clinical outcome. Despite the availability of clinical practice guidelines in our area, the use of diagnostic tests and pharmacological treatment was high(AU)

Efectividad de un protocolo de tratamiento tópico con dimetilsulfóxido al 50% en el síndrome de dolor regional complejo tipo 1 / Efficacy of a topical treatment protocol with dimethyl sulfoxide 50% in type 1 complex regional pain syndrome

Objetivo: Evaluar la efectividad de un protocolo de tratamiento tópico con dimetilsulfóxido ( DMSO) al 50% en el alivio de los procesos inflamatorios en el síndrome de dolor regional complejo (SDRC) tipo 1 con menos de un año de evolución. Métodos Estudio retrospectivo realizado en un hospital de traumatología en pacientes con SDRC tipo 1 en los que se pauta un algoritmo terapéutico normalizado con administración escalonada de fármacos por vía oral y de técnicas intervencionistas. Además se procede a la aplicación tópica de una pomada de DMSO al 50% como fórmula magistral. El período de seguimiento, hasta el alta o durante un año si persiste la enfermedad, e incluye 6 visitas: basal, 15 días, un mes, 3 meses, 6 meses y un año. Evaluación realizada mediante variable principal de eficacia: escala analógica visual (VAS), y con variables secundarias: escala Likert para la calidad de vida, y la variable de medida de la capacidad física de las extremidades (arcos de movilidad, fuerza, función global del miembro). Además se procede a la realización de una encuesta diseñada para el estudio. Resultados Globalmente la disminución de VAS en los 29 pacientes fue de 3,09 puntos. La escala tipo Likert se modificó a 1,36 puntos en positivo. La medida de la capacidad física de las extremidades aumentó a 12,03 en arcos de movilidad, a 3 en fuerza y a función global moderada. Conclusiones La aplicación tópica de DMSO al 50% asociado a un algoritmo terapéutico ha disminuido la intensidad del dolor en VAS, con resultados cada vez más cercanos a la ausencia del mismo, y una puntuación de mejoría en la encuesta de calidad de vida. El DMSO al 50% vía tópica, constituye una herramienta adicional en el arsenal terapéutico del SDRC tipo 1, con escasos efectos secundarios y que aporta una sensación global del alivio y disminución de la rigidez (AU)

Objective: Evaluate the efficacy of a topical treatment protocol with DMSO 50% to alleviate inflammatory processes in type 1 complex regional pain syndrome (CRPS) with a course of less than 1 year. Method: Retrospective study performed in a traumatology hospital on patients with type1 CRPS for whom a standard treatment algorithm was prescribed with stepwise administration of oral drugs and interventional techniques. Patients also received topical DMSO 50% cream as a magistral formula. The follow-up period, lasting until patient discharge, or during 1 year for persistent cases, included 6 visits: baseline, 15 days, 1 month, 3 months, 6 months, and 1 year. The evaluation was performed using a visual analogue scale (VAS) as the main efficacy variable. Secondary variables were the Likert scale for quality of life and the limb capacity variable(range of motion, strength, overall limb function). A questionnaire designed for the study wasalso given. Results: Overall decrease in VAS score in the 29 patients was 3.09 points. The Likert scale score increased by 1.36 points. The scores measuring limb capacity increased to 12.03 for range of motion and to 3 in strength with overall function rated «moderate». Conclusions: Topical application of DMSO 50% associated with a treatment algorithm decreased pain intensity according to the VAS score with results approaching absence of pain, and led to higher scores on the quality of life questionnaire. Topical DMSO 50% is an additional tool for use in treating CRPS I. Its side effects are scarce and it provides an overall sense of relief and lessens rigidity (AU)

[Epidemiology, clinical features and medical interventions in children hospitalized for bronchiolitis]. / Características epidemiológicas, clínicas y terapéuticas de lactantes hospitalizados por bronquiolitis.

OBJECTIVES: To describe the epidemiology, clinical characteristics and treatments prescribed in children with bronchiolitis admitted to our hospital. MATERIAL AND METHODS: Observational, descriptive and prospective study of children younger than 18 months, admitted to Hospital Virgen de la Arrixaca of Murcia (Spain), with the diagnosis of bronchiolitis, during the season of maximum incidence (December 2008-April 2009). RESULTS: A total of 235 infants were admitted, of whom 78.7% of them were aged 5 months or less. We found a positive correlation between the number of cigarettes smoked by their mothers during pregnancy and the number of hospitalization and oxygen therapy days. Children whose mothers were smokers at the time of their admission needed a greater number of oxygen therapy days. Also infants who were not breastfed needed oxygen therapy during more days. Just under one quarter (23.8%) of them had underlying diseases, with prematurity being the most frequent and a risk factor for the ongoing of oxygen therapy and hospital stay. The use of diagnostic tests, bronchodilators, corticosteroids and antibiotics was high. The onset of high temperature was associated with an increased use of antibiotics in outside and inside the hospital setting. An abnormal chest X-ray or a raised C-reactive protein was associated with a higher use of antibiotics. Respiratory Syncytial virus (RSV) was the main aetiological agent, followed by Rhinovirus, Bocavirus, Adenovirus and Metapneumovirus CONCLUSIONS: The majority of hospital admissions due to bronchiolitis took place during the first months of life. Infants whose mothers smoked during pregnancy had a worse clinical outcome. Despite the availability of clinical practice guidelines in our area, the use of diagnostic tests and pharmacological treatment was high.

Actitudes, creencias y conocimientos de los pediatras sobre salud medioambiental en Murcia / Pediatrician attitudes, beliefs and knowledge about environmental health in Murcia, Spain

Objetivo: Estudiar las actitudes, las creencias y los conocimientos sobre salud medioambiental pediátrica (SMAP) de los pediatras de la Región de Murcia (RM). Método: Encuesta autocumplimentada, basada en los conocimientos teórico-prácticos sobre SMAP, enviada por correo postal en 2007 a los 293 pediatras que trabajan en la RM. Resultados: Respondieron 164 (56%). El 70% trabaja en atención primaria. El 5% pertenece a alguna organización no gubernamental medioambiental. Según los pediatras, los factores que más afectan a la salud infantil (sobre una puntuación máxima de 10) son: contaminantes del aire interior-tabaco (7,78), lesiones/accidentes (6,64) y contaminación del aire exterior (5,13). El 45% no registra información ambiental en las historias clínicas. Las consultas más frecuentes de los padres (de 1 a 4) son sobre lesiones y accidentes (2,16), radiación ultravioleta (2,06) y contaminación del agua de bebida (2,05). Las enfermedades respiratorias son las más relacionadas con la salud medioambiental. Conclusiones: Se debería asegurar que el contenido de la SMAP sea obligatorio en la enseñanza y la preparación de los futuros pediatras (pregrado, posgrado, formación continuada). Este trabajo podría ayudar a evaluar las necesidades y planificarlas acciones formativas en SMAP(AU)

Objective: To study pediatrician attitudes, beliefs and knowledge about pediatric environmental health (PEH) in the region of Murcia, Spain. Method: Were mailed a self administered survey based on theoretical and practical knowledge about issues related to PEH of 293 paediatricians working in the Region of Murcia. Results: The overall response rate was 56%. About 70% of respondents worked in Primary Care and 5% belonged to anon-governmental organization (NGO). Pediatricians stated that the factors most affecting the health of children (maximum score 10) were: indoor air pollutants (7.78) injuries and accidents (6.64), and outdoor air pollution (5.13). 45% did not systematically record information about the environments in the clinical registry. The most frequently asked questions by parents were (maximum score 4) related to: injuries and accidents (2.16), ultraviolet radiation (2.06) and contamination of drinking water (2.05). Pediatricians considered respiratory diseases to be most strongly related to the environment. Conclusions: Pediatric associations and institutions should include an EH syllabus in the curriculum of pregraduate and graduate students as well as in the continuing education of paediatricians. This work would help needs assessment and planning the training in PEH(AU)

[Efficacy of a topical treatment protocol with dimethyl sulfoxide 50% in type 1 complex regional pain syndrome]. / Efectividad de un protocolo de tratamiento tópico con dimetilsulfóxido al 50% en el síndrome de dolor regional complejo tipo 1.

OBJECTIVE: Evaluate the efficacy of a topical treatment protocol with DMSO 50% to alleviate inflammatory processes in type 1 complex regional pain syndrome (CRPS) with a course of less than 1 year. METHOD: Retrospective study performed in a traumatology hospital on patients with type 1 CRPS for whom a standard treatment algorithm was prescribed with stepwise administration of oral drugs and interventional techniques. Patients also received topical DMSO 50% cream as a magistral formula. The follow-up period, lasting until patient discharge, or during 1 year for persistent cases, included 6 visits: baseline, 15 days, 1 month, 3 months, 6 months, and 1 year. The evaluation was performed using a visual analogue scale (VAS) as the main efficacy variable. Secondary variables were the Likert scale for quality of life and the limb capacity variable (range of motion, strength, overall limb function). A questionnaire designed for the study was also given. RESULTS: Overall decrease in VAS score in the 29 patients was 3.09 points. The Likert scale score increased by 1.36 points. The scores measuring limb capacity increased to 12.03 for range of motion and to 3 in strength with overall function rated «moderate¼. CONCLUSIONS: Topical application of DMSO 50% associated with a treatment algorithm decreased pain intensity according to the VAS score with results approaching absence of pain, and led to higher scores on the quality of life questionnaire. Topical DMSO 50% is an additional tool for use in treating CRPS I. Its side effects are scarce and it provides an overall sense of relief and lessens rigidity.

La enfermera experta en el cuidado del paciente crítico según Patricia Benner / The nurse expert in the care of the critical patients according to Patricia Benner

Introducción Al hablar de cuidados resulta impensable separar al individuo de su contexto más inmediato, la familia. Incorporarla en los cuidados de un paciente crítico supone una habilidad que no se desarrolla hasta que el profesional de enfermería es competente en términos de Benner. La habilidad que pueda tener la enfermera para implicarse en el cuidado de los pacientes y de la familia se adquiere con el tiempo y la experiencia.ObjetivoExplorar el comportamiento y el juicio clínico de la enfermera experta en áreas de cuidados críticos, según Patricia Benner, identificando las respuestas que esta ofrece a las necesidades del paciente y la familia.MetodologíaSe escogió a María, enfermera experta en una unidad de cuidados intensivos que relató un episodio clínico significativo relacionado con el cuidado a la familia. La lectura de la narración, el análisis y las conclusiones se realizaron, desde el dominio del cuidado a la familia, según los seis aspectos del juicio clínico y del comportamiento experto que señala Benner.ResultadosSe muestra cómo la expertez y el saber hacer de la enfermera impulsan un cambio importante en la práctica.ConclusionesAnimar a la familia a participar en los cuidados facilita la unión, decrece la impotencia y la ansiedad y ayuda a asimilar la situación del ser querido, aspectos que forman parte de la competencia enfermera para proporcionar un cuidado integral. A partir de la práctica clínica de María, se han podido observar los aspectos del juicio clínico y del comportamiento que Benner identifica en una enfermera experta(AU)

Introduction When discussing care, the individual cannot be considered separate from their most immediate context, that is, the family. Including the family in the cares for a critically ill patient requires a skill that is not developed until the nursing professional is competent in Benner's terms. The skill that a nurse can have to become involved in caring for patients and the family is acquired over time and through experience.ObjectiveTo explore the behavior and clinical judgment of a nurse qualified in areas of critical care, according to Patricia Benner, identifying the responses provided by the nurse for patient and family needs.MethodMaria, an expert nurse in an intensive care unit, was selected to report on a significant clinical episode related to caring for the family. Her narration was read, and analysis and conclusions were carried out, within the field of caring for the family and according to the six aspects of clinical judgment and expert behavior outlined by Benner.ResultsIt reveals how the expert skills and know-how of the nurse bring about a significant change in the practice.ConclusionsEncouraging the family to take part in the care promotes union, decreases impotence and anxiety and helps to assimilate the loved one's situation, aspects which form part of the nursing skill to provide complete care. Using Maria's clinical practice as a base, aspects of the clinical judgment and behavior that Benner identifies in an expert nurse can be observed (AU)

[The nurse expert in the care of the critical patients according to Patricia Benner]. / La enfermera experta en el cuidado del paciente crítico según Patricia Benner.

INTRODUCTION: When discussing care, the individual cannot be considered separate from their most immediate context, that is, the family. Including the family in the cares for a critically ill patient requires a skill that is not developed until the nursing professional is competent in Benner's terms. The skill that a nurse can have to become involved in caring for patients and the family is acquired over time and through experience. OBJECTIVE: To explore the behavior and clinical judgment of a nurse qualified in areas of critical care, according to Patricia Benner, identifying the responses provided by the nurse for patient and family needs. METHOD: Maria, an expert nurse in an intensive care unit, was selected to report on a significant clinical episode related to caring for the family. Her narration was read, and analysis and conclusions were carried out, within the field of caring for the family and according to the six aspects of clinical judgment and expert behavior outlined by Benner. RESULTS: It reveals how the expert skills and know-how of the nurse bring about a significant change in the practice. CONCLUSIONS: Encouraging the family to take part in the care promotes union, decreases impotence and anxiety and helps to assimilate the loved one's situation, aspects which form part of the nursing skill to provide complete care. Using Maria's clinical practice as a base, aspects of the clinical judgment and behavior that Benner identifies in an expert nurse can be observed.

Magnetic resonance imaging of the equine temporomandibular joint anatomy.

REASONS FOR PERFORMING STUDY: In human medicine, magnetic resonance imaging (MRI) is considered the 'gold standard' imaging procedure to assess the temporomandibular joint (TMJ). However, there is no information regarding MRI evaluation of equine TMJ. OBJECTIVES: To describe the normal sectional MRI anatomy of equine TMJ by using frozen and plastinated anatomical sections as reference; and determine the best imaging planes and sequences to visualise TMJ components. METHODS: TMJs from 6 Spanish Purebred horse cadavers (4 immature and 2 mature) underwent MRI examination. Spin-echo T1-weighting (SE T1W), T2*W, fat-suppressed (FS) proton density-weighting (PDW) and fast spin-echo T2-weighting (FSE T2W) sequences were obtained in oblique sagittal, transverse and dorsal planes. Anatomical sections were procured on the same planes for a thorough interpretation. RESULTS: The oblique sagittal and transverse planes were the most informative anatomical planes. SE T1W images showed excellent spatial resolution and resulted in superior anatomic detail when comparing to other sequences. FSE T2W sequence provided an acceptable anatomical depiction but T2*W and fat-suppressed PDW demonstrated higher contrast in visualisation of the disc, synovial fluid, synovial pouches and articular cartilage. CONCLUSIONS: The SE T1W sequence in oblique sagittal and transverse plane should be the baseline to identify anatomy. The T2*W and fat-suppressed PDW sequences enhance the study of the articular cartilage and synovial pouches better than FSE T2W. POTENTIAL RELEVANCE: The information provided in this paper should aid clinicians in the interpretation of MRI images of equine TMJ and assist in the early diagnosis of those problems that could not be diagnosed by other means.

Validación de la clasificación funcional de la bipedestación del Hospital de Sagunto / Validation of the functional ambulation classification of the Hospital of Sagunto

Introducción: La bipedestación es una de las facultades más importantes y características del ser humano, imprescindible para la mayoría de las tareas funcionales. Por eso es una de las funciones habitualmente exploradas en Rehabilitación. Existen varios test de valoración funcional, pero ninguno es rápido y sencillo ni valora exclusivamente la bipedestación; es por ello que se desarrolló la clasificación funcional de la bipedestación del Hospital de Sagunto (BipHS). El objetivo del presente trabajo es demostrar la fiabilidad y la validez de esta escala utilizando para ello, como patrón de referencia, la posturografía. Material y métodos: Utilizando la escala BipHS, que cuenta con 6 niveles de función autoexcluyentes y autoexplicativos (nivel 0: imposible, 1: completamente dependiente, 2: mano dependiente, 3: libre, 4: prolongada, 5: normal), se evaluó la bipedestación en 36 pacientes con ictus y 10 sujetos sanos por parte de dos observadores independientes, efectuando un análisis de la concordancia entre observadores. Registramos diversos parámetros del equilibrio con un equipo de posturografía y efectuamos un análisis de comparación y correlación entre el nivel de bipedestación de nuestra escala y los valores de la posturografía. Resultados: La concordancia entre observadores fue muy buena, con un índice kappa de Cohen de 0,83 (IC: 0,69–0,97). Obtuvimos una asociación significativa entre las medidas del desplazamiento del centro de presiones (cdp) y la escala BipHS, con una buena correlación lineal. A mejor nivel funcional, mejor equilibrio y menores desplazamientos del cdp. Conclusiones: La escala de BipHS es una escala fiable y válida para valorar el equilibrio en bipedestación (AU)

Introduction: Standing is one of the most important and characteristic features of human beings, indispensable for most functional tasks. Therefore, it is one of the functions usually explored in rehabilitation. There are several tests of functional valuation but none of them are quick and easy neither do they evaluate exclusively standing, fact due to which the Standing scale of the "Hospital de Sagunto" (BipHS) was developed. The aim of this work is to demonstrate the reliability and validity of this scale using, as a standard the posturography analysis. Material and methods: Using BipHS Scale, which takes into account 6 levels of function which are self-excluding and self-explanatory (level 0: imposible, 1: completely dependent, 2: hand-dependent, 3: free, 4: prolonged, 5: normal), we evaluated standing in 36 patients which had suffered a vascular stroke and 10 healthy individuals, using two independent observers making a analysis of agreement between both. We then registered different parameters of equilibrium using posturography and made a comparison and correlation analysis between the level of standing of our scale and the values of posturography. Results: The resulting kappa index was 0,83 (CI: 0,69-0,97), proving a good concordance between observers. We achieved a significant association between the measures of movement of the center of pressure (cp) and the BipHS Scale, with a good linear correlation. The better the functional level, the better the balance and smaller displacement of the cp. Conclusion: BipHS is a trustworthy and valid scale to evaluate standing (AU)

Computed tomographic anatomy of the temporomandibular joint in the young horse.

REASONS FOR PERFORMING STUDY: The equine temporomandibular joint (TMJ) and its surrounding structures can be difficult to investigate in cases with a clinical problem related to the region. Little previous attention has been given either to a computed tomographic (CT) imaging protocol for the joint or an interpretation of the structures displayed in CT images of the normal joint. OBJECTIVES: To provide a CT atlas of the normal cross-sectional anatomy of the equine TMJ using frozen and plastinated sections as anatomical reference. METHODS: Eight TMJs from 4 immature pure-bred Spanish horses were examined by helical CT. Scans were processed with a detailed algorithm to enhance bony and soft tissue. Transverse CT images were reformatted into sagittal and dorsal planes. Transverse, sagittal and dorsal cryosections were then obtained, photographed and plastinated. Relevant anatomic structures were identified in the CT images and corresponding anatomical sections. RESULTS: In the CT images, a bone window provided excellent bone detail, however, the soft tissue components of the TMJ were not as well visualised using a soft tissue window. The articular cartilage was observed as a hyperattenuating stripe over the low attenuated subchondral bone and good delineation was obtained between cortex and medulla. The tympanic and petrous part of the temporal bone (middle and inner ear) and the temporohyoid joint were seen in close proximity to the TMJ. CONCLUSIONS: Helical CT provided excellent images of the TMJ bone components to characterise the CT anatomy of the normal joint. POTENTIAL RELEVANCE: Detailed information is provided that may be used as a reference by equine veterinarians for the CT investigation of the equine TMJ and serve to assist them in the diagnosis of disorders of the TMJ and related structures (middle and inner ear). The study was performed at an immature stage and further studies of mature individuals are required in order to confirm that the clinical interpretation is not affected by changes occurring with age.

[Review of 22 patients with 22q11.2 deletion syndrome: phenotype spectrum]. / Revisión de 22 casos de deleción 22q11.2: espectro fenotípico.

INTRODUCTION: The 22q11.2 deletion syndrome is a contiguous gene deletion syndrome with an incidence rate of 1/4,000-6,000 live births. The most specific clinical features are: congenital conotruncal heart diseases, palate anomalies, hypocalcaemia, immunity and learning problems, and a characteristic facial phenotype. The objective of this work is to review the presenting phenotype and clinical features of children with 22q11.2 deletion syndrome as a guide for early diagnosis. PATIENTS AND METHODS: Retrospective study of 22 patients with 22q11.2 deletion syndrome diagnosed at our hospital in the time period 2004-2007. Variables analyzed: incidence, sex, age at diagnosis, presenting phenotype, clinical features, positive family history, mortality and natural history. RESULTS: From a total of 22 patients, 63 % were males, and the median age at diagnosis was of 4.5 years. Presenting pheno-type: congenital heart disease, milestones delay, velopharyngeal incompetence, hypocalcaemia, and mental retardation/psychiatric disturbances. CLINICAL FEATURES: congenital heart disease (84 %), velopharyngeal incompetence (47 %), milestones delay and learning disabilities (79 %). All of the deletions were de novo, except in one case where the deletion was present as mosaicism in the father. Three patients died, due to congenital heart disease. CONCLUSIONS: Clinical expression is widely variable, although a characteristic phenotype exists. Patients with heart disease are diagnosed earlier than other patients with unusual presenting phenotype such as congenital dysphagia. It is important to recognize less common phenotypes at early ages in order to provide multidisciplinary monitoring and accurate genetic counselling.

Revisión de 22 casos de deleción 22q11.2: espectro fenotípico / Review of 22 patients with 22q11.2 deletion syndrome: phenotype spectrum

Introducción: El síndrome de deleción 22q11.2 es un síndrome de genes contiguos con una incidencia de un caso por cada 4.000-6.000 recién nacidos. Posee una amplia variabilidad clínica y sus características clínicas más frecuentes son cardiopatía conotruncal, anomalías palatinas, hipocalcemia, problemas de inmunidad y de aprendizaje, y un fenotipo facial característico. El objetivo de este estudio es revisar las formas de presentación y las manifestaciones clínicas de los niños con deleción 22q11.2 como guía para su diagnóstico precoz. Pacientes y métodos: Estudio retrospectivo de 22 casos de deleción 22q11.2 diagnosticados en nuestro hospital entre los años 2004 y 2007, en que se analizan las siguientes variables: incidencia, sexo, edad en el momento del diagnóstico, forma de presentación, características clínicas, antecedentes familiares, mortalidad y evolución. Resultados: De los 22 pacientes, el 63 % fueron varones y la edad media en el momento de realizar el diagnóstico fue de 4,5 años. Las formas de presentación fueron cardiopatía, retraso psicomotor, insuficiencia velopalatina, hipocalcemia y retraso mental o alteraciones psiquiátricas. Las principales manifestaciones clínicas fueron cardiopatía (84 %), insuficiencia velopalatina (47 %), retraso psicomotor y problemas de aprendizaje (79 %). Todos los casos fueron deleciones de novo, salvo un caso en el que se identificó la deleción "en mosaico" en el padre. Fallecieron 3 pacientes a causa de cardiopatía. Conclusiones: La expresión clínica es muy variable, aunque existe un fenotipo característico. Los niños con cardiopatía conotruncal son diagnosticados más tempranamente, pero en otras formas de presentación, como la disfagia congénita, el diagnóstico se retrasa más. Es necesario tener en cuenta las formas de presentación menos habituales para identificar en edades tempranas a estos pacientes y proporcionarles una atención multidisciplinaria temprana y un asesoramiento genético familiar adecuado (AU)

Introduction: The 22q11.2 deletion syndrome is a contiguous gene deletion syndrome with an incidence rate of 1/4,000-6,000 live births. The most specific clinical features are: congenital conotruncal heart diseases, palate anomalies, hypocalcaemia, immunity and learning problems, and a characteristic facial phenotype. The objective of this work is to review the presenting phenotype and clinical features of children with 22q11.2 deletion syndrome as a guide for early diagnosis. Patients and methods: Retrospective study of 22 patients with 22q11.2 deletion syndrome diagnosed at our hospital in the time period 2004-2007. Variables analyzed: incidence, sex, age at diagnosis, presenting phenotype, clinical features, positive family history, mortality and natural history. Results: From a total of 22 patients, 63 % were males, and the median age at diagnosis was of 4.5 years. Presenting pheno-type: congenital heart disease, milestones delay, velopharyngeal incompetence, hypocalcaemia, and mental retardation/psychiatric disturbances. Clinical features: congenital heart disease (84 %), velopharyngeal incompetence (47 %), milestones delay and learning disabilities (79 %). All of the deletions were de novo, except in one case where the deletion was present as mosaicism in the father. Three patients died, due to congenital heart disease. Conclusions: Clinical expression is widely variable, although a characteristic phenotype exists. Patients with heart disease are diagnosed earlier than other patients with unusual presenting phenotype such as congenital dysphagia. It is important to recognize less common phenotypes at early ages in order to provide multidisciplinary monitoring and accurate genetic counseling (AU)