[Bacterial meningitis. Clinical-epidemiological study. Review of 8 years (1988-1995)]. / Meningitis bacterianas. Estudio clínico-epidemiológico. Revisión de 8 años (1988-1995).

OBJECTIVE: The objective of this study was to determine the epidemiological and clinical characteristics of the bacterial meningitis assisted in the Hospital Materno-Infantil of Complejo Hospitalario Carlos Haya of Malaga. PATIENTS AND METHODS: The epidemiological, clinical, biological and therapeutical aspects are analyzed between the period of January 1988 to December 1995. RESULTS: The number of cases was 322, with the pathogen known in 240 (74.6%) and undetermined in 82 cases (24.6%). Meningococcal meningitis was the predominant cause with 162 cases (67.5%), followed by Haemophilus influenzae (40 cases, 16.7%) and pneumococcal meningitis (27 cases, 11.3%). Neisseria meningitidis type B was the most common serogroup, with an increasing number of type C from 1993.

[Prognostic value and accuracy of crisis indicators in severe asthma]. / Valor pronóstico y precisión de los indicadores de crisis asmática severa.

OBJECTIVE: The objective of this study was to evaluate the predictive index of several scores such as the Scarfone score. Wood-Downes modified by Ferrés and transcutaneous oxygen saturation. (Stc,O2) for the detection of severe asthma exacerbations. PATIENTS AND METHODS: A transverse study design was used. Sixty patients under 15 years of age admitted consecutively with acute asthma were included in the study. We evaluated the relation (Pearson "r" correlation), precision (sensibility and specificity) and odds ratio (logistic regression) of the scores and Stc,O2 with the number of salbutamol doses required by the patients during their hospitalization. RESULTS: The number of doses of bronchodilator needed to revert acute asthma relates to the hospital stay (r = 0.74, p < 0.0002), to all the scores taken into account (r > 0.65, 0 < 0.001) an to the Stc,O2 (r = -0.66, p < 0.001). The evaluated scores are prognostic factors for severe acute asthma, while heart rate and respiratory rate did not predict severe acute asthma. CONCLUSIONS: We have to identify, treat and classify as having severe acute asthma those patients who after receiving three doses of inhaled bronchodilator show a Scarfone score over 10 or a Ferrés score over 8, these being situations related to an increased need of bronchodilator therapy and a longer hospital stay.

[Acute respiratory failure secondary to Pneumocystis carinii pneumonia in children]. / Fracaso respiratorio agudo secundario a neumonía por Pneumocystis carinii en la infancia.

OBJECTIVE: The objective of this study was to ascertain the clinical and epidemiological characteristics of Pneumocystis carinii pneumonia (PCP) cases admitted to the Pediatric Intensive Care Unit (PICU). PATIENTS AND METHODS: A retrospective study was carried out on the 8 PCP cases admitted to the PICU from July 1991 to September 1994. The variables studied were: age, sex, geographic origin, associated pathology, immunological status, clinical manifestations, biochemical data, radiology, findings in bronchoalveolar lavage fluid (BAL), response to therapy and clinical follow-up. RESULTS: Age of the patients varied between 3 months and 9 years and there were 5 males and 3 females. Associated pathologies included AIDS (4 cases), severe combined immunodeficiency (SCID), Job's syndrome, and immunodeficiencies secondary to non-Hodgkin's lymphoma (NHL) and acute lymphoid leukemia (ALL), one case of each. Four cases appeared in a 22 day period. All cases but one suffered acute respiratory failure and needed mechanical ventilation. Diagnosis was established by means of BAL in every case. All cases showed a bilateral diffuse alveolo-interstitial pattern on chest films. Treatment was trimethoprim-sulfamethoxazole. In the acute illnesses, 2 patients died (cases of terminal SCID and NHL). CONCLUSIONS: To date, epidemic presentation of PCP has not been reported in our community. Four of our cases, with no demonstrable previous relation, appeared over a short period of time. We have not found a relationship between LDH levels and severity, as expressed by mechanical ventilation time. Every AIDS case survived the acute episode and CD4 counts were normal in most cases.