Insulin eye drops for refractory corneal epithelial defects. A case series / Colirio de insulina para defectos corneales epiteliales persistentes. Una serie de casos

Objetive: To report the clinical course of a case series of patients with persistent epithelial corneal defects (PECD) treated with insulin eye drops. Method: Retrospective review of five patients -four non-diabetic and one diabetic- in treatment with insulin eye drops 1 U/mL four times a day (QID). Results: Patients developed refractory epithelial ulcers due to different etiology (three infections, one trauma and one chemical injury). After treatment with topical insulin all defects were healed in about 30-60 days. Conclusion: Insulin formulated as 1 U/mL eye drops and administered QID can be an effective and safe option for PECD. (AU)

Objetivo: Comunicar la evolución clínica de una serie de casos de pacientes con defectos corneales epiteliales persistentes (PECD) tratados con colirio de insulina. Método: Revisión retrospectiva de cinco pacientes –cuatro no diabéticos y uno diabético– en tratamiento con colirio de insulina 1 U/mL cuatro veces al día (QID). Resultados: Los pacientes desarrollaron úlceras epiteliales refractarias de diferente etiología (tres infecciones, un traumatismo y una lesión química). Tras el tratamiento con insulina tópica todos las lesiones se curaron en unos 30-60 días. Conclusión: La insulina formulada en forma de colirio de 1 U/mL y administrada QID puede ser una opción eficaz y segura para la PECD. (AU)

Outcomes of the PIRASOA programme, an antimicrobial stewardship programme implemented in hospitals of the Public Health System of Andalusia, Spain: an ecologic study of time-trend analysis.

OBJECTIVES: Inappropriate antimicrobial use favours the spread of resistance, and multidrug-resistant microorganisms (MDR) are currently of major concern. Antimicrobial stewardship programmes (ASPs) are essential for improving antibiotic use in hospitals. However, their impact on entire healthcare systems has not been thoroughly assessed. Our objective was to provide the results of an institutionally supported ASP involving 31 public hospitals in Andalusia, Spain. METHODS: We designed an ecologic time-series study from 1 January 2014 to 31 December 2017. Quarterly, data on indicators were collected prospectively, and feedback reports were provided. PIRASOA is an ongoing clinically based quality-improvement programme whose key intervention is the educational interview, regular peer-to-peer interventions between advisors and prescribers to reinforce the appropriate use of antibiotics. Seventy-two indicators were monitored to measure prescribing quality (inappropriate treatments), antimicrobial consumption (defined daily doses per 1000 occupied bed-days), incidence density of MDR per 1000 occupied bed-days and crude mortality rate associated with bloodstream infections. We used Joinpoint regression software to analyse the trends. RESULTS: The quality of antimicrobial prescribing improved markedly, and the inappropriate treatment rate was significantly lower, with quarterly percentage change (QPC) = -3.0%, p < 0.001. Total antimicrobial consumption decreased (QPC = -0.9%, p < 0.001), specifically carbapenems, amoxicillin/clavulanic acid, quinolones and antifungal agents, whereas antipseudomonal cephalosporin use increased. While the incidence of MDR showed a sustained decreasing trend (QPC = -1.8%; p 0.002), the mortality of patients with bloodstream infections remained stable (QPC = -0.2%, p 0.605). CONCLUSIONS: To date, the PIRASOA programme has succeeded in optimizing the use of antimicrobial agents and has had a positive ecologic result on bacterial resistance at level of an entire healthcare system.

[Mortality and associated factors of patients with complex chronic diseases in rural and social transformation areas in Andalusia]. / Mortalidad y factores asociados de los pacientes con enfermedades crónicas complejas del ámbito rural y zonas de transformación social en Andalucía.

OBJECTIVE: To determine one-year mortality and associated factors in patients with complex chronic diseases (CCP) in rural health centres and social transformation needs areas (STNA) in Primary Health Care (PHC) in Andalusia. MATERIAL AND METHODS: Design: 1-Year longitudinal observational prospective open study. SETTING: 40 health centre. SUBJECTS: consenting subjects over 18yr according multiple health condition criteria. SAMPLE SIZE: 814 subjects (confidence interval 95%, alpha risk 0.03%, p=.2; 20% of sample increase due to possible losses). End-point: 1-year Mortality. INDEPENDENT VARIABLES: socio-demographic, socio-familial, clinical, functional (Barthel Index -BI-, Lawton-Brody Index), cognitive (Pfeiffer Test), prescribed drugs, social healthcare resources consumption, and quality of life (EQ-5D). DATA SOURCE: Interview and computerised clinical history Results: A total of 832 CCP were included (48.8% women). One-year mortality was 17.8% (n=148). Logistic regression model for mortality included: aged 85 and over, having a caregiver, haemoglobin level less 10g/L, hospital admission in last year, BI under 60 points, and active neoplasia. The calibration obtained from model was good (p=.85 in the Hosmer-Lemeshow goodness-of-fit test), and the discrimination power also good (AUC=0.772 [0.68-0.77] in ROC curve). CONCLUSIONS: 1-year mortality of CCP in rural centres and STNA in PHC was 17.8%. Knowledge of the factors related to the mortality of CCP helps to approach the needs and social-health resources management.

Codon Usage Heterogeneity in the Multipartite Prokaryote Genome: Selection-Based Coding Bias Associated with Gene Location, Expression Level, and Ancestry.

Prokaryotes represent an ancestral lineage in the tree of life and constitute optimal resources for investigating the evolution of genomes in unicellular organisms. Many bacterial species possess multipartite genomes offering opportunities to study functional variations among replicons, how and where new genes integrate into a genome, and how genetic information within a lineage becomes encoded and evolves. To analyze these issues, we focused on the model soil bacterium Sinorhizobium meliloti, which harbors a chromosome, a chromid (pSymB), a megaplasmid (pSymA), and, in many strains, one or more accessory plasmids. The analysis of several genomes, together with 1.4 Mb of accessory plasmid DNA that we purified and sequenced, revealed clearly different functional profiles associated with each genomic entity. pSymA, in particular, exhibited remarkable interstrain variation and a high density of singletons (unique, exclusive genes) featuring functionalities and modal codon usages that were very similar to those of the plasmidome. All this evidence reinforces the idea of a close relationship between pSymA and the plasmidome. Correspondence analyses revealed that adaptation of codon usages to the translational machinery increased from plasmidome to pSymA to pSymB to chromosome, corresponding as such to the ancestry of each replicon in the lineage. We demonstrated that chromosomal core genes gradually adapted to the translational machinery, reminiscent of observations in several bacterial taxa for genes with high expression levels. Such findings indicate a previously undiscovered codon usage adaptation associated with the chromosomal core information that likely operates to improve bacterial fitness. We present a comprehensive model illustrating the central findings described here, discussed in the context of the changes occurring during the evolution of a multipartite prokaryote genome.IMPORTANCE Bacterial genomes usually include many thousands of genes which are expressed with diverse spatial-temporal patterns and intensities. A well-known evidence is that highly expressed genes, such as the ribosomal and other translation-related proteins (RTRPs), have accommodated their codon usage to optimize translation efficiency and accuracy. Using a bioinformatic approach, we identify core-genes sets with different ancestries, and demonstrate that selection processes that optimize codon usage are not restricted to RTRPs but extended at a genome-wide scale. Such findings highlight, for the first time, a previously undiscovered adaptation strategy associated with the chromosomal-core information. Contrasted with the translationally more adapted genes, singletons (i.e., exclusive genes, including those of the plasmidome) appear as the gene pool with the less-ameliorated codon usage in the lineage. A comprehensive summary describing the inter- and intra-replicon heterogeneity of codon usages in a complex prokaryote genome is presented.

Adaptation of antibiotic treatment to clinical practice guidelines in patients aged ⩾65 years hospitalised due to community-acquired pneumonia.

Early, conforming antibiotic treatment in elderly patients hospitalised for community-acquired pneumonia (CAP) is a key factor in the prognosis and mortality. The objective was to examine whether empirical antibiotic treatment was conforming according to the Spanish Society of Pulmonology and Thoracic Surgery guidelines in these patients. Multicentre study in patients aged ⩾65 years hospitalised due to CAP in the 2013-14 and 2014-15 influenza seasons. We collected socio-demographic information, comorbidities, influenza/pneumococcal vaccination history and antibiotics administered using a questionnaire and medical records. Bivariate analyses and multilevel logistic regression were made. In total, 1857 hospitalised patients were included, 82 of whom required intensive care unit (ICU) admission. Treatment was conforming in 51.4% (95% confidence interval (CI) 49.1-53.8%) of patients without ICU admission and was associated with absence of renal failure without haemodialysis (odds ratio (OR) 1.49, 95% CI 1.15-1.95) and no cognitive dysfunction (OR 1.71, 95% CI 1.25-2.35), when the effect of the autonomous community was controlled for. In patients with ICU admission, treatment was conforming in 45.1% (95% CI 34.1-56.1%) of patients and was associated with the hospital visits in the last year (<3 vs. ⩾3, OR 2.70, 95% CI 1.03-7.12) and there was some evidence that this was associated with season. Although the reference guidelines are national, wide variability between autonomous communities was found. In patients hospitalised due to CAP, health services should guarantee the administration of antibiotics in a consensual manner that is conforming according to clinical practice guidelines.

Application of a multivariate analysis method for non-target screening detection of persistent transformation products during the cork boiling wastewater treatment.

Cork boiling wastewater is a very complex mixture of naturally occurring compounds leached and partially oxidized during the boiling cycles. The effluent generated is recalcitrant and could cause a significant environmental impact. Moreover, if this untreated industrial wastewater enters a municipal wastewater treatment plant it could hamper or reduce the efficiency of most activated sludge degradation processes. Despite the efforts to treat the cork boiling wastewater for reusing purposes, is still not well-known how safe these compounds (original compounds and oxidation by-products) will be. The purpose of this work was to apply an HPLC-high resolution mass spectrometry method and subsequent non-target screening using a multivariate analysis method (PCA), to explore relationships between samples (treatments) and spectral features (masses or compounds) that could indicate changes in formation, degradation or polarity, during coagulation/flocculation (C/F) and photo-Fenton (PhF). Although, most of the signal intensities were reduced after the treatment line, 16 and 4 new peaks were detected to be formed after C/F and PhF processes respectively. The use of this non-target approach showed to be an effective strategy to explore, classify and detect transformation products during the treatment of an unknown complex mixture.

Cork boiling wastewater treatment and reuse through combination of advanced oxidation technologies.

Industrial preparation of cork consists of its immersion for approximately 1 hour in boiling water. The use of herbicides and pesticides in oak tree forests leads to absorption of these compounds by cork; thus, after boiling process, they are present in wastewater. Cork boiling wastewater shows low biodegradability and high acute toxicity involving partial inhibition of their biodegradation when conventional biological treatment is applied. In this work, a treatment line strategy based on the combination of advanced physicochemical technologies is proposed. The final objective is the reuse of wastewater in the cork boiling process; thus, reducing consumption of fresh water in the industrial process itself. Coagulation pre-treatment with 0.5 g/L of FeCl3 attained the highest turbidity elimination (86 %) and 29 % of DOC elimination. Similar DOC removal was attained when using 1 g/L of ECOTAN BIO (selected for ozonation tests), accompanied of 64 % of turbidity removal. Ozonation treatments showed less efficiency in the complete oxidation of cork boiling wastewater, compared to solar photo-Fenton process, under the studied conditions. Nanofiltration system was successfully employed as a final purification step with the aim of obtaining a high-quality reusable permeate stream. Monitoring of unknown compounds by LC-QTOF-MS allowed the qualitative evaluation of the whole process. Acute and chronic toxicity as well as biodegradability assays were performed throughout the whole proposed treatment line.

A consolidated analysis of the physiologic and molecular responses induced under acid stress in the legume-symbiont model-soil bacterium Sinorhizobium meliloti.

Abiotic stresses in general and extracellular acidity in particular disturb and limit nitrogen-fixing symbioses between rhizobia and their host legumes. Except for valuable molecular-biological studies on different rhizobia, no consolidated models have been formulated to describe the central physiologic changes that occur in acid-stressed bacteria. We present here an integrated analysis entailing the main cultural, metabolic, and molecular responses of the model bacterium Sinorhizobium meliloti growing under controlled acid stress in a chemostat. A stepwise extracellular acidification of the culture medium had indicated that S. meliloti stopped growing at ca. pH 6.0-6.1. Under such stress the rhizobia increased the O2 consumption per cell by more than 5-fold. This phenotype, together with an increase in the transcripts for several membrane cytochromes, entails a higher aerobic-respiration rate in the acid-stressed rhizobia. Multivariate analysis of global metabolome data served to unequivocally correlate specific-metabolite profiles with the extracellular pH, showing that at low pH the pentose-phosphate pathway exhibited increases in several transcripts, enzymes, and metabolites. Further analyses should be focused on the time course of the observed changes, its associated intracellular signaling, and on the comparison with the changes that operate during the sub lethal acid-adaptive response (ATR) in rhizobia.

Prevalence of anti-rubella, anti-measles and anti-mumps IgG antibodies in neonates and pregnant women in Catalonia (Spain) in 2013: susceptibility to measles increased from 2003 to 2013.

Non-immune neonates and non-immune pregnant women are at risk of developing rubella, measles and mumps infections, including congenital rubella syndrome. We describe the seroepidemiology of measles, mumps and rubella (MMR) in neonates and pregnant women in Catalonia (Spain). Anti-rubella, anti-measles and anti-mumps serum IgG titres were assessed using enzyme-linked immunosorbent assay (ELISA) tests in 353 cord blood samples from neonates of a representative sample of pregnant women obtained in 2013. The prevalence of protective antibody titres in neonates was 96 % for rubella IgG (≥8 IU/ml), 90 % for measles IgG (>300 IU/ml) and 84 % for mumps IgG (>460 EU/ml). Slightly lower prevalences of protective IgG titres, as estimated from the cord blood titres, were found in pregnant women: 95 % for rubella IgG, 89 % for measles IgG and 81 % for mumps IgG. The anti-measles and anti-mumps IgG titres and the prevalences of protective IgG titres against measles and mumps increased significantly (p < 0.001) with maternal age. The prevalence of protective anti-measles IgG titres decreased by 7 % [odds ratio (OR) = 0.15, p < 0.001), the prevalence of protective anti-rubella IgG titres increased by 3 % (OR = 1.80, p < 0.05) and the MMR vaccination coverage (during childhood) in pregnant women increased by 54 % (OR = 2.09, p < 0.001) from 2003 to 2013. We recommend to develop an MMR prevention programme in women of childbearing age based on mass MMR vaccination or MMR screening and vaccination of susceptible women to increase immunity levels against MMR.

Development of new positive-selection RIVET tools: detection of induced promoters by the excision-based transcriptional activation of an aacCI (GmR)-gfp fusion.

RIVET (Recombination Based in vivo Expression Technology) is a powerful genetic tool originally conceived for the identification of genes induced in complex biological niches where conventional transcriptomics is difficult to use. With a broader application, genetic recombination-based technologies have also been used, in combination with regulatory proteins and specific transcriptional regulators, for the development of highly sensitive biosensor systems. RIVET systems generally comprise two modules: a promoter-trap cassette generating genomic transcriptional fusions to the tnpR gene encoding the Tn-γδ TnpR resolvase, and a reporter cassette carrying res-flanked selection markers that are excised upon expression of tnpR to produce an irreversible, inheritable phenotypic change. We report here the construction and validation of a new set of positive-selection RIVET systems that, upon induction of the promoter-trap module, generate the transcriptional activation of an antibiotic-resistant and a green-fluorescent phenotype. Two classes of promoter-trap tools were constructed to generate transcriptional fusions to tnpR: one based on the use of a narrow-host-range plasmid (pRIVET-I), integrative in several Gram-negative bacteria, and the other based on the use of a broad-host-range plasmid (pRIVET-R). The system was evaluated in the model soil bacterium Sinorhizobium meliloti, where a clear-cut phenotypic transition from Nm(R)-Gm(S)-GFP(-) to Nm(S)-Gm(R)-GFP(+) occurred upon expression of tnpR. A S. meliloti integrative RIVET library was constructed in pRIVET-I and, as expected, changes in the extracellular conditions (e.g., salt stress) triggered a significant increase in the appearance of Gm(R)-GFP(+) (excised) clones. The sacB-independent positive-selection RIVET systems here described provide suitable basic tools both for the construction of new recombination-based biosensors and for the search of bacterial markers induced when microorganisms colonize and invade complex environments and eukaryotic hosts.

[Reactions to infliximab infusions in dermatologic patients: consensus statement and treatment protocol. Working Group of the Grupo Español de Psoriasis de la Academia Española de Dermatología y Venereología ]. / Reacciones a la infusión de infliximab en pacientes dermatológicos. Grupo de Estudio, Grupo Español de Psoriasis de la Academia Española de Dermatología y Venereología.

Infliximab is a chimeric monoclonal antibody that binds to and blocks tumor necrosis factor alpha and is the most effective biologic agent approved for the treatment of moderate-to-severe psoriasis. It is administered by intravenous infusion, usually in day hospitals on an outpatient basis. The main problem with the administration of infliximab is the possibility of infusion reactions, which may be immediate or delayed; these reactions are related to the immunogenicity of this monoclonal antibody, leading to the production of anti-infliximab antibodies. Infusion reactions to infliximab are not usually anaphylactic (ie, they are not mediated by immunoglobulin E), and re-exposure of the patient using specific protocols to prevent and treat these reactions is therefore possible. The extensive experience in the use of infliximab for the treatment of rheumatic conditions and chronic inflammatory bowel disease has made it possible to develop infusion reaction management protocols; these can be applied to dermatologic patients, who constitute a growing proportion of patients treated with intravenous biological agents. The aim of this review is to draw up a consensus protocol for the treatment of infusion reactions in dermatologic patients treated with infliximab.

Reacciones a la infusión de infliximab en pacientes dermatológicos / Reactions to Infliximab Infusions in Dermatologic Patients: Consensus Statement and Treatment Protocol

Infliximab, un anticuerpo monoclonal quimérico que se une y bloquea al factor de necrosis tumoral alfa, constituye el agente biológico más eficaz aprobado para el tratamiento de la psoriasis moderada a grave y se administra mediante infusión intravenosa, generalmente en Hospitales de Día de forma ambulatoria. Las reacciones infusionales, que pueden ser agudas y retardadas, constituyen el principal problema en la administración rutinaria de este fármaco, y están relacionadas con la inmunogenicidad del anticuerpo monoclonal que da lugar a la producción de anticuerpos dirigidos contra el mismo. Las reacciones infusionales a infliximab son en la mayoría de los casos no anafilácticas (mediadas por inmunoglobulina E [IgE]), lo que no excluye el retratamiento de los pacientes empleando protocolos específicos de prevención y tratamiento de las mismas. Existe una amplia experiencia sobre el uso de este fármaco en pacientes con enfermedades reumatológicas y enfermedad inflamatoria idiopática intestinal, lo que ha permitido desarrollar protocolos de tratamiento de las reacciones a la infusión aplicables a los pacientes dermatológicos, que constituyen un grupo cada vez más numeroso de los que son tratados con agentes biológicos por vía intravenosa. El objeto de la presente revisión es desarrollar un protocolo de tratamiento consensuado de las reacciones a la infusión en pacientes dermatológicos tratados con infliximab (AU)

Infliximab is a chimeric monoclonal antibody that binds to and blocks tumor necrosis factor α and is the most effective biologic agent approved for the treatment of moderate-to-severe psoriasis. It is administered by intravenous infusion, usually in day hospitals on an outpatient basis. The main problem with the administration of infliximab is the possibility of infusion reactions, which may be immediate or delayed; these reactions are related to the immunogenicity of this monoclonal antibody, leading to the production of anti-infliximab antibodies. Infusion reactions to infliximab are not usually anaphylactic (ie, they are not mediated by immunoglobulin E), and re-exposure of the patient using specific protocols to prevent and treat these reactions is therefore possible. The extensive experience in the use of infliximab for the treatment of rheumatic conditions and chronic inflammatory bowel disease has made it possible to develop infusion reaction management protocols; these can be applied to dermatologic patients, who constitute a growing proportion of patients treated with intravenous biologic agents. The aim of this review is to draw up a consensus protocol for the treatment of infusion reactions in dermatologic patients treated with infliximab (AU)

[Prognostic factors for bronchiolitis complications in a pediatric intensive care unit]. / Factores pronósticos de evolución complicada en la bronquiolitis que requiere ingreso en cuidados intensivos pediátricos.

OBJECTIVE: To analyse the prognostic factors for complications in children with bronchiolitis admitted to a pediatric intensive care unit (PICU). PATIENTS AND METHOD: A retrospective study was performed on children with bronchiolitis admitted into a PICU between 2000 and 2006. Univariate and multivariate analysis were performed to study the prognostic factors of complications, mechanical ventilation requirements, mortality and PICU stays of more than 15 days. RESULTS: A total of 110 patients were studied, of whom 72 (65.5%) had high risk factors: prematurity (39.1%), cardiac disease (38.2%) and bronchopulmonary dysplasia (16.3%). A total of 82.7% of patients had complications; 26% need invasive mechanical ventilation and the mortality was 3.6%, and 16.4% stayed in PICU for more than 15 days. Factors associated with mechanical ventilation were the clinical Wood-Downes score and heart disease. A weight less than 5 kg was associated with complications; heart disease and invasive mechanical ventilation were associated with a longer PICU stay; prematurity and mechanical ventilation were associated with mortality. CONCLUSIONS: Children with bronchiolitis admitted into the PICU had a high frequency of complications, often needed mechanical ventilation and had long stays in the PICU, but the mortality is low. The best prognostic factors on admission into the PICU were the acute respiratory insufficiency score, the presence of heart disease and were premature at birth.

Factores pronósticos de evolución complicada en la bronquiolitis que requiere ingreso en cuidados intensivos pediátricos / Prognostic factors for bronchiolitis complications in a pediatric intensive care unit

Objetivos: analizar los factores pronósticos de evolución complicada de los niños con bronquiolitis aguda que requieren ingreso en cuidados intensivos pediátricos (UCIP). Pacientes y método: se realizó un estudio observacional retrospectivo de los niños con bronquiolitis ingresados en la UCIP entre 2000 y 2006. Se realizó un estudio univariable y multivariable para analizar los factores pronósticos de aparición de complicaciones, necesidad de ventilación mecánica, mortalidad e ingreso en UCIP mayor de 15 días. Resultados: se estudió a 110 pacientes; 72 (65,5%) tenían antecedentes personales de alto riesgo: prematuridad (39,1%), cardiopatía congénita (38,2%) y displasia broncopulmonar (16,3%). El 82,7% de los pacientes presentó complicaciones, el 26% precisó ventilación mecánica invasiva y el 3,6% murió. En un 16,4% de los pacientes el ingreso en UCIP fue mayor de 15 días. Los factores asociados a evolución complicada fueron el estado de gravedad clínico y la presencia de cardiopatía para la ventilación mecánica invasiva; el peso<5kg para las complicaciones; la cardiopatía y la necesidad de ventilación mecánica invasiva para larga duración de ingreso, y la ventilación mecánica invasiva y el antecedente de prematuridad para la mortalidad. Conclusiones: los niños con bronquiolitis que ingresan en UCIP presentan una elevada tasa de complicaciones, precisan frecuentemente ventilación mecánica, tienen una duración de ingreso prolongada, y su mortalidad es baja. Los factores que mejor predicen el pronóstico son la gravedad de la insuficiencia respiratoria en el momento de ingreso del niño en la UCIP, la presencia de cardiopatía y el antecedente de prematuridad (AU)

Objective: To analyse the prognostic factors for complications in children with bronchiolitis admitted to a pediatric intensive care unit (PICU). Patients and method: A retrospective study was performed on children with bronchiolitis admitted into a PICU between 2000 and 2006. Univariate and multivariate analysis were performed to study the prognostic factors of complications, mechanical ventilation requirements, mortality and PICU stays of more than 15 days. Results: A total of 110 patients were studied, of whom 72 (65.5%) had high risk factors: prematurity (39.1%), cardiac disease (38.2%) and bronchopulmonary dysplasia (16.3%). A total of 82.7% of patients had complications; 26% need invasive mechanical ventilation and the mortality was 3.6%, and 16.4% stayed in PICU for more than 15 days. Factors associated with mechanical ventilation were the clinical Wood-Downes score and heart disease. A weight less than 5kg was associated with complications; heart disease and invasive mechanical ventilation were associated with a longer PICU stay; prematurity and mechanical ventilation were associated with mortality. Conclusions: Children with bronchiolitis admitted into the PICU had a high frequency of complications, often needed mechanical ventilation and had long stays in the PICU, but the mortality is low. The best prognostic factors on admission into the PICU were the acute respiratory insufficiency score, the presence of heart disease and were premature at birth(AU)

Trastorno de conversión en una adolescente / No disponible

A partir de la presentación y estudio evolutivo de uncaso, se pretende demostrar la vigencia del trastorno deconversión en la actualidad y, de esta manera, desmitificaresta patología que, desde que tuvo su origen comoentidad nosológica en la época de Charcot, aún es objetode interés clínico y científico.Así se han recopilado los artículos actuales de mayorevidencia científica y se han revisado diversas fuentesbibliográficas que inciden en un antes y un después deeste trastorno.Finalmente se estudia el abordaje psicoterapéuticosegún el modelo cognitivo conductual y las estrategiasque, basadas en este modelo, se han adecuado al caso

According to the exposure and the evolutionarystudy of a concrete case, we are going to show how conversiondisorder is still in force. Therefore, it will becompulsory to demystify certain studies about thispathology, which is nowadays an important issue ofclinic and scientific interest since its origin as a nosologicentity in Charcot’s time.In the beginning, we have been making a compilationof the most interesting and newest articles in whichscientific evidence appears. Furthermore, we have beenchecking several bibliographic sources emphasizing inthe different way of treating this kind of disorder.Finally, we have aimed a psychotherapy analyse bytaking into account the cognitive and conductual pattern,as well as the suitable strategies to our case whichare based on this pattern

[The effect of helium on ventilator parameters: in vitro study with a Servoi ventilator]. / Efecto del helio sobre los parámetros de los respiradores en ventilación mecánica: estudio in vitro con el respirador Servoi.

OBJECTIVE: To analyze the changes in respiratory parameters in a Servoi ventilator with heliox. MATERIAL AND METHODS: In vitro study with a Servoi (Maquet) ventilator in volume controlled (VC), pressure controlled (PC) and volume control regulated by pressure (VCPR) modes connected to an artificial lung. A heliox tank with a fixed concentration of helium 70 % and oxygen 30 % was connected to the air inlet of the ventilator. The ventilator was set in VC mode with tidal volumes of 30, 50, 100, 250 and 500 ml; in PC mode with pressure of 20 and 30 cmH(2)O and in VCPR mode with tidal volume of 150 ml. In each case FiO(2) of 21, 30, 40, 50, 60, 70, 80, 90 and 100 % was used. The FiO(2), inspired and expired tidal volume and inspiratory pressure measured by the ventilator and a pitot spirometer (Datex_S5) were compared. RESULTS: In VC and VCPR modes the increase in helium produced a progressive decrease in the pressure needed to administrate the set volume. Heliox also produced a decrease in the tidal volume measured by the spirometer and the tidal expired volume measured by the respirator. In PC mode, heliox produced a progressive increase in the inspired tidal volume, increasing the differences between inspired and expired tidal volumes. CONCLUSIONS: Heliox used with Servoi ventilator produces a decrease in inspiratory pressures in VC and VCPR modes, and an increase in inspiratory tidal volume in PC mode. In all modes heliox reduced the expired tidal volume measured by the ventilator and the spirometer. These changes should be borne in mind if heliox is used with this ventilator.

Efecto del helio sobre los parámetros de los respiradores en ventilación mecánica: estudio in vitro con el respirador Servoi / The effect of helium on ventilator parameters: in vitro study with a Servoi ventilator

Objetivo: Analizar las modificaciones de los parámetros en el respirador Servoi con distintas concentraciones de héliox. Material y métodos: Estudio experimental en el que se utilizó un respirador Servoi (Maquet) en modalidades de volumen control (VC), presión control (PC) y volumen controlado regulado por presión (VCRP) conectado a un pulmón de artificial. El héliox se administró mediante una bombona con el 70 % de helio y el 30 % de oxígeno conectada a la entrada de aire del respirador. Se programó el respirador en VC con volúmenes corrientes de 30, 50, 100, 250 y 500 ml, en PC con presión de 20 y 30 cmH2O, y en VCRP con volumen corriente de 150 ml. En cada modalidad se programó una FiO2 de 21, 30, 40, 50, 60, 70, 80, 90 y 100 % y se comparó el volumen corriente inspirado, el espirado y la presión inspiratoria pico medidas por el respirador y por un espirómetro colocado entre la tubuladura y el pulmón de prueba y conectado a un monitor Datex_S5. Resultados: En modalidad de VC y VCRP el aumento de la concentración de helio produjo una disminución progresiva del pico de presión necesario para administrar el volumen programado y una disminución en el volumen corriente medido por el espirómetro y el volumen espirado medido por el respirador. En modalidad de PC el héliox produjo un aumento progresivo del volumen corriente inspirado con incremento en las diferencias entre el volumen corriente inspirado y el espirado. Conclusiones: La administración de héliox en el respirador Servoi produce una disminución de las presiones inspiratorias en las modalidades de VC y VCRP y un aumento del volumen corriente inspirado en la modalidad de PC. En todas las modalidades produce una falsa disminución en el volumen corriente espirado medido por el respirador y el espirómetro. Es necesario tener en cuenta estas alteraciones si se utiliza héliox con este respirador (AU)

Objective: To analyze the changes in respiratory parameters in a Servoi ventilator with heliox. Material and methods: In vitro study with a Servoi (Maquet) ventilator in volume controlled (VC), pressure controlled (PC) and volume control regulated by pressure (VCPR) modes connected to an artificial lung. A heliox tank with a fixed concentration of helium 70 % and oxygen 30 % was connected to the air inlet of the ventilator. The ventilator was set in VC mode with tidal volumes of 30, 50, 100, 250 and 500 ml; in PC mode with pressure of 20 and 30 cmH2O and in VCPR mode with tidal volume of 150 ml. In each case FiO2 of 21, 30, 40, 50, 60, 70, 80, 90 and 100 % was used. The FiO2, inspired and expired tidal volume and inspiratory pressure measured by the ventilator and a pitot spirometer (Datex_S5) were compared. Results: In VC and VCPR modes the increase in helium produced a progressive decrease in the pressure needed to administrate the set volume. Heliox also produced a decrease in the tidal volume measured by the spirometer and the tidal expired volume measured by the respirator. In PC mode, heliox produced a progressive increase in the inspired tidal volume, increasing the differences between inspired and expired tidal volumes. Conclusions: Heliox used with Servoi ventilator produces a decrease in inspiratory pressures in VC and VCPR modes, and an increase in inspiratory tidal volume in PC mode. In all modes heliox reduced the expired tidal volume measured by the ventilator and the spirometer. These changes should be borne in mind if heliox is used with this ventilator (AU)

Experiencia con la oxigenoterapia de alto flujo en cánulas nasales en niños / Experience with high-flow nasal cannula oxygen therapy in children

Objetivo. Analizar la eficacia de un sistema de oxigenoterapia de alto flujo en niños con insuficiencia respiratoria moderada y/o necesidades elevadas de oxígeno. Pacientes y métodos.Estudio clínico prospectivo observacional en el que se incluyeron los pacientes tratados con un sistema de oxigenoterapia de alto flujo en cánulas nasales. Se analizaron las siguientes variables: puntuación de gravedad clínica, frecuencia respiratoria, cardíaca, mejoría clínica, saturación de oxígeno, gasometría, aparición de complicaciones y necesidad de ventilación no invasiva tras el inicio del tratamiento. Resultados. Se estudiaron 18 tratamientos en 16 pacientes, 2 niñas y 14 niños, de edades comprendidas entre 2 meses y 13 años. Con el sistema de alto flujo se observó una ligera disminución de la frecuencia respiratoria de 34,5 a 32,2 resp./min; p < 0,04, y un aumento de la saturación de oxígeno (SatO2) del 90,2 al 93,5 %; p < 0,02. Un total de 14 pacientes mejoraron clínicamente y/o permitieron el cambio desde la asistencia respiratoria previa. La duración del tratamiento fue de 3 días (rango 6 h a 25 días). En 2 pacientes se observaron complicaciones leves que no obligaron a suspender el tratamiento (irritabilidad inicial y excesiva humedad). No se observaron infecciones respiratorias secundarias. En cuatro pacientes el sistema fue retirado: en dos por falta de mejoría, en otro por empeoramiento tras mejoría inicial, y en el cuarto por fallo en la regulación de temperatura del aparato. Conclusiones. El sistema de oxigenoterapia de alto flujo es eficaz en un elevado porcentaje de niños con necesidades elevadas de oxígeno y/o insuficiencia respiratoria moderada

Objective. To analyze the efficacy of a high-flow oxygen therapy system in children with moderate respiratory failure and/or high oxygen requirements. Patients and methods. We performed a prospective, observational clinical study of patients treated with a high-flow oxygen therapy system via nasal cannulae. The following variables were analyzed: clinical severity score, respiratory rate, heart rate, clinical improvement, oxygen saturation, blood gases, complications, and the need for ventilation after starting the treatment. Results. Eighteen treatments were studied in 16 patients (two girls and 14 boys) aged between 2 and 156 months. With the high-flow oxygen therapy system, respiratory rate slightly decreased from 34.5 bpm to 32.2 bpm (p < 0.04) and O2 saturation increased from 90.2 % to 93.5 % (p < 0.02). Fourteen patients showed a clinical improvement and/or tolerated the change from the previous respiratory assistance. The duration of treatment was 3 days (range: 6 hours to 25 days). Mild complications (initial irritability and excessive humidity) were observed in two patients, but treatment interruption was not required. No secondary respiratory tract infections were observed. The system was withdrawn in four patients, due to lack of improvement in two patients, deterioration after initial improvement in one patient, and failure of the system's temperature regulation in one patient. Conclusions. The high-flow oxygen therapy system is effective in a large percentage of children with high oxygen requirements and/or moderate respiratory failure

[Energy expenditure in critically ill children: correlation with clinical characteristics, caloric intake, and predictive equations]. / Consumo calórico en el niño crítico: relación con las características clínicas, el aporte calórico y las fórmulas teóricas de cálculo de las necesidades.

OBJECTIVE: To study energy expenditure (EE) in critically ill infants and children and its correlation with clinical characteristics, treatment, nutrition, caloric intake, and predicted energy expenditure calculated through theoretical formulas. PATIENTS AND METHODS: A prospective observational study was conducted in critically ill infants and children. Indirect calorimetry measurements were performed using the calorimetry module of the S5 Datex monitor. Data on mechanical ventilation, nutrition, and caloric intake were registered. Theoretical equations of energy requirement (WHO/FAO, Harris-Benedict, Caldwell-Kennedy, Maffeis, Fleisch, Kleiber and Hunter) were calculated. The statistical analysis was performed using the SPSS 12.0 package. RESULTS: Sixty-eight EE determinations were performed in 43 critically ill infants and children aged between 10 days and 15 years old. Measured EE was 58.4 (18.4) kcal/kg/day, with wide individual variability. EE was significantly lower in infants and children who had undergone cardiac surgery than in the remainder. No correlation was found between EE and mechanical ventilation parameters, vasoactive drugs, sedatives, or muscle relaxants. A correlation was found between caloric intake and EE. In a high percentage of patients, predictive equations did not accurately estimate EE. The respiratory quotient was not useful to diagnose overfeeding or underfeeding. CONCLUSIONS: Wide individual variability in EE was found in critically ill infants and children. Predictive equations did not accurately estimate EE. Indirect calorimetry measured by a specific module is a simple method that could allow generalized use of EE measurement in critically ill pediatric patients undergoing mechanical ventilation.