Heterogeneity of sensitization profiles and clinical phenotypes among patients with seasonal allergic rhinitis in Southern European countries-The @IT.2020 multicenter study.

BACKGROUND: Pollen allergy poses a significant health and economic burden in Europe. Disease patterns are relatively homogeneous within Central and Northern European countries. However, no study broadly assessed the features of seasonal allergic rhinitis (SAR) across different Southern European countries with a standardized approach. OBJECTIVE: To describe sensitization profiles and clinical phenotypes of pollen allergic patients in nine Southern European cities with a uniform methodological approach. METHODS: Within the @IT.2020 multicenter observational study, pediatric and adult patients suffering from SAR were recruited in nine urban study centers located in seven countries. Clinical questionnaires, skin prick tests (SPT) and specific IgE (sIgE) tests with a customized multiplex assay (Euroimmun Labordiagnostika, Lübeck, Germany) were performed. RESULTS: Three hundred forty-eight children (mean age 13.1 years, SD: 2.4 years) and 467 adults (mean age 35.7 years SD: 10.0 years) with a predominantly moderate to severe, persistent phenotype of SAR were recruited. Grass pollen major allergenic molecules (Phl p 1 and/or Phl p 5) ranged among the top three sensitizers in all study centers. Sensitization profiles were very heterogeneous, considering that patients in Rome were highly poly-sensitized (sIgE to 3.8 major allergenic molecules per patient), while mono-sensitization was prominent and heterogeneous in other cities, such as Marseille (sIgE to Cup a 1: n = 55/80, 68.8%) and Messina (sIgE to Par j 2: n = 47/82, 57.3%). Co-sensitization to perennial allergens, as well as allergic comorbidities also broadly varied between study centers. CONCLUSIONS: In Southern European countries, pollen allergy is heterogeneous in terms of sensitization profiles and clinical manifestations. Despite the complexity, a unique molecular, multiplex, and customized in-vitro IgE test detected relevant sensitization in all study centers. Nevertheless, this geographical diversity in pollen allergic patients imposes localized clinical guidelines and study protocols for clinical trials of SAR in this climatically complex region.

Validation of a Spanish version of the EuroPrevall Food Allergy Quality of Life Questionnaire-Parental Form

Background: Food allergy can have a major impact on quality of life of children and their parents. Questionnaires have been developed to measure the impact of this disorder. We aimed to validate the EuroPrevall questionnaire on Food Allergy-Quality of Life Questionnaire, Parent Form (FAQLQ-PF) and the Food Allergy Independent Measure (FAIM), translated into Spanish. Methods: The internal consistency of the FAQLQ-PF and the FAIM, translated into Spanish (Spain) and completed by the parents of 74 children with IgE-mediated food allergy, were evaluated with Cronbach's alpha. To test construct validity of the FAQLQ-PF, its correlation with the FAIM was also calculated. To assess their discriminant validity, we compared the values of both depending on the number of offending foods and for children with and without anaphylaxis. Results: The values of Cronbach's alpha for the three domains in the FAQLQ-PF were over 0.9. The value of alpha for FAIM questions was below 0.6, which was attributed to the wording of one question. When this question was removed, alpha increased to over 0.70. There was a significant correlation between the FAQLQ-PF score and the FAIM. There were significantly poorer FAQLQ-PF scores in children with more food allergies and worse FAIM in those who had had anaphylaxis. Conclusions: The Spanish version of the FAQLQ-PF had a good internal consistency, good construct validity and validity to discriminate patients with more food allergies and anaphylaxis. It can be used as a tool to evaluate and monitor the quality of life in families with food allergic children (AU)

No disponible

Validation of a Spanish version of the EuroPrevall Food Allergy Quality of Life Questionnaire-Parental Form.

BACKGROUND: Food allergy can have a major impact on quality of life of children and their parents. Questionnaires have been developed to measure the impact of this disorder. We aimed to validate the EuroPrevall questionnaire on Food Allergy-Quality of Life Questionnaire, Parent Form (FAQLQ-PF) and the Food Allergy Independent Measure (FAIM), translated into Spanish. METHODS: The internal consistency of the FAQLQ-PF and the FAIM, translated into Spanish (Spain) and completed by the parents of 74 children with IgE-mediated food allergy, were evaluated with Cronbach's alpha. To test construct validity of the FAQLQ-PF, its correlation with the FAIM was also calculated. To assess their discriminant validity, we compared the values of both depending on the number of offending foods and for children with and without anaphylaxis. RESULTS: The values of Cronbach's alpha for the three domains in the FAQLQ-PF were over 0.9. The value of alpha for FAIM questions was below 0.6, which was attributed to the wording of one question. When this question was removed, alpha increased to over 0.70. There was a significant correlation between the FAQLQ-PF score and the FAIM. There were significantly poorer FAQLQ-PF scores in children with more food allergies and worse FAIM in those who had had anaphylaxis. CONCLUSIONS: The Spanish version of the FAQLQ-PF had a good internal consistency, good construct validity and validity to discriminate patients with more food allergies and anaphylaxis. It can be used as a tool to evaluate and monitor the quality of life in families with food allergic children.

Evaluación clínico-radiológica de la técnica de aloinjerto compactado y vástago cementado en cirugías de revisión de cadera / Clinical-radiological evaluation of the impaction allografting and cemented rod technique in revision knee surgery

Objetivo. Evaluar a largo plazo, el resultado clínico-radiológico, la supervivencia y las complicaciones intra y postoperatorias de pacientes intervenidos de cirugía de revisión de cadera mediante esta técnica. Material y métodos. Estudio analítico observacional, prospectivo y no aleatorizado de 26 pacientes intervenidos de cirugía de revisión de cadera en nuestro hospital (1997-1998), a los que se les realizó un seguimiento clínico-radiológico y un análisis de la supervivencia del implante. Resultados. Se observan diferencias estadísticamente significativas en los valores pre y postoperatorios de las escalas de Harris y de Merle D'Aubigne. La supervivencia del implante teniendo en cuenta como punto final la cirugía de revisión fue del 84% a los 13 años. Hubo 9 complicaciones intraoperatorias (6 de ellas fueron fracturas) e influyeron de forma significativa en la estancia hospitalaria. El 70% de los pacientes no tuvo ninguna complicación postoperatoria. Ninguna de las variables analizadas influyó en el hundimiento radiográfico de los implantes. Discusión. Diversas técnicas intentan solventar el déficit de stock óseo en las cirugías de revisión de cadera, pero solo una intenta recuperarlo, el injerto compactado. Conclusiones. La técnica de Ling ofrece una mejoría clínica tanto en la escala de Merle D'Aubigne como en la de Harris, a medio-largo plazo. La presentación de complicaciones intraoperatorias incrementa la estancia hospitalaria y los días necesarios para iniciar la sedestación. La técnica de Ling es una buena opción a tener en cuenta en pacientes jóvenes en los que es previsible que haya una nueva cirugía de revisión en el futuro (AU)

Objective. Long term clinical and radiological evaluation of results, survival, and peri- operative and post-operative complications of the patients who have been operated on for revision total hip arthroplasty using the impaction allografting and cemented rod technique. Material and methods. An observational, analytical, prospective and non-random study was conducted on 26 patients who underwent revision total hip arthroplasty in our Hospital (1997-98). They were clinically and radiologically assessed, and a survival analysis of the implant was performed. Results. Statistically significant differences were identified in the pre- and post-operative values, according to Harris and Merle D'Aubigne scores. The femoral components survival was considered as an endpoint of the revision replacement, which was 84% at a mean of 13 years. There were 9 intraoperative complications (6 were fractures) and they significantly affected the length of hospital stay. No post-operative complications were observed in 70% of the patients. None of the analysed variables had any influence on the radiological subsidence of the femoral component. Discussion. Several techniques aim to solve the bone stock deficiency in revision total hip arthroplasty, but only impaction grafting attempts to recover it. Conclusions. The Ling's technique shows an improvement over the Merle D'Aubigne and Harris scores, in the medium-long term. The intraoperative complications are mainly an increase in the length of hospital stay and the number of days needed to be able to sit down. Ling's technique is a good option to consider in young patients where it is foreseeable that there is a new revision surgery in the future (AU)

[Clinical-radiological evaluation of the impaction allografting and cemented rod technique in revision knee surgery]. / Evaluación clínico-radiológica de la técnica de aloinjerto compactado y vástago cementado en cirugías de revisión de cadera.

OBJECTIVE: Long term clinical and radiological evaluation of results, survival, and peri- operative and post-operative complications of the patients who have been operated on for revision total hip arthroplasty using the impaction allografting and cemented rod technique. MATERIAL AND METHODS: An observational, analytical, prospective and non-random study was conducted on 26 patients who underwent revision total hip arthroplasty in our Hospital (1997-98). They were clinically and radiologically assessed, and a survival analysis of the implant was performed. RESULTS: Statistically significant differences were identified in the pre- and post-operative values, according to Harris and Merle D́Aubigne scores. The femoral components survival was considered as an endpoint of the revision replacement, which was 84% at a mean of 13 years. There were 9 intraoperative complications (6 were fractures) and they significantly affected the length of hospital stay. No post-operative complications were observed in 70% of the patients. None of the analysed variables had any influence on the radiological subsidence of the femoral component. DISCUSSION: Several techniques aim to solve the bone stock deficiency in revision total hip arthroplasty, but only impaction grafting attempts to recover it. CONCLUSIONS: The Ling's technique shows an improvement over the Merle D́Aubigne and Harris scores, in the medium-long term. The intraoperative complications are mainly an increase in the length of hospital stay and the number of days needed to be able to sit down. Ling's technique is a good option to consider in young patients where it is foreseeable that there is a new revision surgery in the future.

Cryptosporidium hominis genotypes involved in increased incidence and clusters of cases, Navarra, Spain, 2012.

SUMMARY Two clusters of confirmed cryptosporidiosis infections were detected in Navarra, Spain, in the summer of 2012, in the context of an increased incidence in the region. Molecular subtyping of Cryptosporidium hominis determined that one cluster, occurring in an urban area, was due to the predominant circulating subtype IbA10G2R2 and the other cluster, with cases occurring in a rural area, was due to a rare subtype IaA18R3. No single exposure was associated with infection, although exposure to certain children's pools was reported by a majority of patients interviewed in each cluster. Genotyping tools were useful in the investigation and could aid investigation of cryptosporidiosis outbreaks in Spain in the future.

Avances en el diagnóstico de la alergia / Advances in the diagnosis of the allergy

No disponible

Resultados del cotilo con doble movilidad de última generación en España (135 PTC seguidas durante una media de 32 meses) / Results of the latest generation dual-mobility cup in spain (135 THAs followed-up for a mean of 32 months)

Introducción: En este estudio multicéntrico (Hospital de Cabueñes y Hospital Universitario Santa Lucía) se evalúan los resultados de una serie retrospectiva y continua de 135 PTC realizadas implantando un cotilo doble movilidad de nueva generación. Material y métodos: Se estudiaron 135 PTC intervenidas entre 2005 y 2008. El seguimiento medio fue de 32 meses. Las causas de la cirugía fueron 31.8% coxartrosis y 68.1% fracturas de cadera. La edad media era de 82.1 años. Todos los pacientes eran revisados periódicamente haciendo una valoración clínica y radiográfica. Resultados: El seguimiento pudo ser realizado durante más de 24 meses en 121 PTC (14 pacientes fallecidos). En la última revisión, mayo 2011: 119 cótilos no presentaban aflojamiento. Las complicaciones fueron: 2 luxaciones postquirúrgicas; 4 TVP; 3 infecciones PTH; 5 fracturas peri PTC; 2 aflojamientos cetilo y 1 hundimiento vástago. HHS preoperatorio medio: 45, 83 y postoperatorio medio: 80, 03. De los 135 cotilos revisados sólo dos presentaban modificaciones radiográficas sin signos clínicos. La supervivencia aislada del cótilo a los 12 meses fue 97.03% (87.3-99.2) con un intervalo de confianza del 95% y a los 5 años, un 96.7% (85.4-98.8). Discusión: En nuestro estudio el nuevo cótilo doble movilidad ha mostrado buenos resultados en las siguientes indicaciones: coxartrosis primaria y fracturas de cuello de fémur. Conclusión: Las complicaciones obtenidas en esta serie aparecen en el mismo porcentaje que en otras series de la literatura excepto para la luxación. En ésta, el porcentaje (1.48%) era mucho más pequeño que el de las series clásicas, especialmente en los pacientes con problemas neuromusculares o cognitivos (un tercio de los pacientes).

Introduction: This multi-center study (Cabueñes Hospital and Santa Lucía University Hospital) assessed the results of a retrospective and ongoing series of 135 total hip arthroplasties (THA) in which a latest generation dual-mobility cup was implanted. Material and methods: A total of 135 THAs performed between 2005 and 2008 were analyzed. Mean follow-up was 32 months. The causes of surgery were: coxarthrosis in 31.8% and hip fracture in 68.1%. Mean age was 82.1 years. All patients were seen at regular follow-up visits for clinical and radiological assessments. Results: The follow-up lasted over 24 months in 121 THAs (14 patients died). In the most recent follow-up, in May 2011, 119 cups did not show any loosening. Complications were as follows: 2 postoperative dislocations; 4 DVTs; 3 infections; 5 periprosthetic fractures; 2 loosened cups, and one subsided stem. The mean preoperative Harris Hip Score (HHS) was 45, 83; the mean postoperative HHS was 80, 03. Only two of the 135 cups analyzed had radiographic modifications without clinical signs. Isolated cup survival at 12 months was 97.03% (87.3-99.2) with a 95% confidence interval; survival at 5 years was 96.7% (85.4-98.8). Discussion: In our study, the new dual-mobility cup showed good results for the following indications: primary coxarthrosis and femur neck fractures. Conclusion: The complication rate in our series was similar to the one reported in other series in the literature, except for dislocation. The latter was considerably less frequent (1.48%) in our series compared to the rates reported by the classical series, especially in patients with neuromuscular or cognitive problems (one third of patients).

EAACI food allergy and anaphylaxis guidelines: managing patients with food allergy in the community.

The European Academy of Allergy and Clinical Immunology (EAACI) Food Allergy and Anaphylaxis Guidelines, managing patients with food allergy (FA) in the community, intend to provide guidance to reduce the risk of accidental allergic reactions to foods in the community. This document is intended to meet the needs of early-childhood and school settings as well as providers of non-prepackaged food (e.g., restaurants, bakeries, takeaway, deli counters, and fast-food outlets) and targets the audience of individuals with FA, their families, patient organizations, the general public, policymakers, and allergists. Food allergy is the most common trigger of anaphylaxis in the community. Providing children and caregivers with comprehensive information on food allergen avoidance and prompt recognition and management of allergic reactions are of the utmost importance. Provision of adrenaline auto-injector devices and education on how and when to use these are essential components of a comprehensive management plan. Managing patients at risk of anaphylaxis raises many challenges, which are specific to the community. This includes the need to interact with third parties providing food (e.g., school teachers and restaurant staff) to avoid accidental exposure and to help individuals with FA to make safe and appropriate food choices. Education of individuals at risk and their families, their peers, school nurses and teachers as well as restaurant and other food retail staff can reduce the risk of severe/fatal reactions. Increased awareness among policymakers may improve decision-making on legislation at local and national level.

[Results of the latest generation dual-mobility cup in Spain (135 THAs followed-up for a mean of 32 months)]. / Resultados del cotilo con doble movilidad de última generación en España (135 PTC seguidas durante una media de 32 meses).

INTRODUCTION: This multi-center study (Cabuenes Hospital and Santa Lucia University Hospital) assessed the results of a retrospective and ongoing series of 135 total hip arthroplasties (THA) in which a latest generation dual-mobility cup was implanted. MATERIAL AND METHODS: A total of 135 THAs performed between 2005 and 2008 were analyzed. Mean follow-up was 32 months. The causes of surgery were: coxarthrosis in 31.8% and hip fracture in 68.1%. Mean age was 82.1 years. All patients were seen at regular follow-up visits for clinical and radiological assessments. RESULTS: The follow-up lasted over 24 months in 121 THAs (14 patients died). In the most recent follow-up, in May 2011, 119 cups did not show any loosening. Complications were as follows: 2 postoperative dislocations; 4 DVTs; 3 infections; 5 periprosthetic fractures; 2 loosened cups, and one subsided stem. The mean preoperative Harris Hip Score (HHS) was 45, 83; the mean postoperative HHS was 80.03. Only two of the 135 cups analyzed had radiographic modifications without clinical signs. Isolated cup survival at 12 months was 97.03% (87.3-99.2) with a 95% confidence interval; survival at 5 years was 96.7% (85.4-98.8). DISCUSSION: In our study, the new dual-mobility cup showed good results for the following indications: primary coxarthrosis and femur neck fractures. CONCLUSION: The complication rate in our series was similar to the one reported in other series in the literature, except for dislocation. The latter was considerably less frequent (1.48%) in our series compared to the rates reported by the classical series, especially in patients with neuromuscular or cognitive problems (one third of patients).

Minimally invasive hip surgery: the approach did not make the difference.

BACKGROUND: We hypothesized that minimally invasive surgery was superior to conventional surgery for total hip arthroplasty procedure. PURPOSE: To compare the results of total hip replacement (THR) made by minimally invasive lateral approach with the results of THR made by conventional lateral approach. MATERIALS AND METHODS: Prospective, randomized trial. Fifty patients were selected and then divided into two groups based on utilized approach. DATA COLLECTED: Perioperative bleeding, postoperative pain, time of recovery, components orientation, complications and functional results. Five-year follow-up. RESULTS: No differences were found in blood loss, postoperative pain, surgical time, components orientation, rate of complications or functional result. Minimally invasive lateral approach produced faster recovery with less hospital stay and earlier walking start. CONCLUSION: Our results suggested that minimally invasive lateral approach has not provided significant benefits over conventional lateral approach for the implantation of a total hip arthroplasty.

Inestabilidad de la artroplastia total de cadera. Una aproximación desde los criterios de la evidencia científica / Instability of total hip arthroplasty: An approach using the scientific evidence

La inestabilidad en las artroplastias de cadera o la luxación en su forma más dramática, es una complicación que altera la evolución de este procedimiento introduciendo una pérdida de bienestar en el paciente y una pérdida de confianza en su relación con el cirujano. Si no consideramos los fracasos por infección, la luxación supone la causa más frecuente de cirugía de revisión a corto y medio plazo y no es desdeñable el número de casos que precisan varias intervenciones para aportar estabilidad a la articulación. A pesar de la frecuencia y gravedad de esta complicación no son frecuentes estudios con alta evidencia científica en este tema. Hemos pretendido recoger la literatura publicada con su grado de evidencia acerca de la etiopatogenia, profilaxis y tratamiento de esta eventualidad. Para ello además de anotar y resumir los hallazgos de cada trabajo, hemos añadido el nivel de evidencia tras la cita bibliográfica correspondiente (AU)

The instability in hip arthroplasty, or joint dislocation in its most dramatic form, is a complication that changes the outcome of this procedure, causing a decrease in the quality of life of the patients, and a loss of confidence in their relationship with the surgeon. If we discount failures due to infection, dislocation is the most frequent cause of a short to medium term revision, and the number of cases that require several operations to provide stability to the joint is not insignificant. Despite the frequency and severity of this complication there are few studies with a high level of scientific evidence on this subject. We have attempted to review the published literature and its level of evidence on the pathogenic origin, prophylaxis and treatment of this eventuality. As well as recording and summarising the findings of each study in this review, we have added the evidence level of the corresponding literature reference (AU)

Food anaphylaxis in antiphospholipid syndrome and thrombosis

Background: We have observed that some cases of food anaphylaxis were followed by severe thrombosis associated to anticardiolip in antibodies. Food anaphylaxis associated with antiphospholipid syndrome has seldom been published. Objective: The aims were: 1) to test anticardiolipin antibodies in an important number of patients with anaphylaxis due to vegetal foods and their relationship with possible thrombosis; and 2) to study seed and fruit hypersensitivity in patients with previous thrombotic events associated with antiphospholipid antibodies (aCL). Methods: We included 30 patients diagnosed of thrombosis associated with a CL, 52 patients who suffered from anaphylaxis due to seeds or fruits, and 120 control patients. Haematological, cardiopulmonary vascular and rheumatologic studies had been performed as needed. In vivo and in vitro allergy tests with a large battery of vegetal allergens were carried out in all the patients. Measurement of IgG a CL antibodies and specific IgE to vegetal food was done by ELISA and CAP-FEIA (Phadia). Immunodetection and inhibitions with lipoproteins belonging to seedswere performed. Results: Seventy-five percent of the patients diagnosed as having antiphospholipid primary syndrome had specific IgE against different proteins from different vegetable allergens, most of them seeds, and clearly against lipoproteins that were also recognised by the patients with food anaphylaxis but not by the control cases. Among the patients with anaphylaxis, 28% had anticardiolipin antibodies and 17.3% thrombosis. Conclusion: Our study suggests that seed lipoproteins which cause severe food anaphylaxis might have a potential role in the antiphospholipid syndrome and related thrombosis (AU)

Food anaphylaxis in antiphospholipid syndrome and thrombosis.

BACKGROUND: We have observed that some cases of food anaphylaxis were followed by severe thrombosis associated to anticardiolipin antibodies. Food anaphylaxis associated with antiphospholipid syndrome has seldom been published. OBJECTIVE: The aims were: 1) to test anticardiolipin antibodies in an important number of patients with anaphylaxis due to vegetal foods and their relationship with possible thrombosis; and 2) to study seed and fruit hypersensitivity in patients with previous thrombotic events associated with antiphospholipid antibodies (aCL). METHODS: We included 30 patients diagnosed of thrombosis associated with aCL, 52 patients who suffered from anaphylaxis due to seeds or fruits, and 120 control patients. Haematological, cardiopulmonary vascular and rheumatologic studies had been performed as needed. In vivo and in vitro allergy tests with a large battery of vegetal allergens were carried out in all the patients. Measurement of IgG aCL antibodies and specific IgE to vegetal food was done by ELISA and CAP-FEIA (Phadia). Immunodetection and inhibitions with lipoproteins belonging to seeds were performed. RESULTS: Seventy-five percent of the patients diagnosed as having antiphospholipid primary syndrome had specific IgE against different proteins from different vegetable allergens, most of them seeds, and clearly against lipoproteins that were also recognised by the patients with food anaphylaxis but not by the control cases. Among the patients with anaphylaxis, 28% had anticardiolipin antibodies and 17.3% thrombosis. CONCLUSION: Our study suggests that seed lipoproteins which cause severe food anaphylaxis might have a potential role in the antiphospholipid syndrome and related thrombosis.

Caracterización de la pandemia de gripe A H1N1 2009 en Navarra / The 2009 H1N1 influenza pandemic in Navarre, Spain

Fundamento. Describir la actividad gripal durante la pandemia de 2009-2010 en Navarra y compararla con la de temporadas anteriores. Métodos. Se han analizado los casos de gripe notificados en atención primaria y todas las confirmaciones virológicas realizadas en pacientes de atención primaria y en hospitales de Navarra entre las semanas 21 de 2009 y 20 de 2010. Resultados. El virus de la gripe A (H1N1) 2009 se detectó en Navarra entre las semana 23 de 2009 a la 2 de 2010, periodo en el que se registraron 39 casos con diagnóstico médico de síndrome gripal por 1.000 habitantes. El umbral epidémico se superó en dos periodos, con un pico en julio y otro mayor en noviembre. La mayor incidencia se alcanzó en niños de 5 a 14 años (121 por mil), seguidos por el grupo de menores de 5 años. Se produjeron 224 hospitalizaciones (36 por 100.000 habitantes) con confirmación de gripe A H1N1 2009, 8% de ellos requirieron ingreso en unidades de cuidados intensivos y hubo cuatro defunciones (0,6 por 100.000 habitantes). La tasa de hospitalizaciones fue mayor en niños menores de 5 años (163 por 100.000 habitantes), mientras que la probabilidad de derivación a cuidados intensivos aumentó con la edad. Conclusión. A pesar de no haber dispuesto de una vacuna específica hasta que la temporada estaba muy avanzada, el virus de gripe A (H1N1) 2009 produjo una onda gripal en rangos similares a los de otras temporadas y su repercusión en hospitalizaciones y casos graves fue moderada (AU)

Background. To describe influenza activity during the2009-2010 pandemic in Navarre and compare it to previous seasons. Methods. An analysis was made of all influenza-like illness cases reported in primary care and all the virological confirmations made in patients in primary care and in hospitals of Navarre between week 21 of 2009 and week 20 of 2010. Results. Influenza 2009 H1N1 virus was detected in Navarre between week 23 of 2009 and week 2 of 2010, a period when 39 medically diagnosed cases of influenza-like illness per 1,000 inhabitants were registered. The epidemicthres hold was surpassed in two periods, with a peak in July and a greater one in November. The greatest incidence was reached in children aged between 5 and 14 years (121 per thousand), followed by the group of under fives.There were 224 hospitalisations (36 per 100,000 inhabitants)with confirmation of influenza 2009 H1N1 virus, 8% of whom required admission to intensive care units and there were four deaths (0.6 per 100,000 inhabitants). The rate of hospitalisation was greater amongst children under five (163 per 100,000 inhabitants), while the probability of referral to intensive care increased with age. Conclusion. In spite of not having a specific vaccine available until the season was very well advanced, influenza 2009 H1N1 virus produced a wave of cases with similar incidence to those of other seasons and its repercussion in hospitalizations and serious cases was moderate (AU)

Abordaje posterior mínimamente invasivo en artroplastia total de cadera. Estudio prospectivo y aleatorizado. Un año de seguimiento / Minimally invasive posterior approach in total hip arthroplasty. Prospective randomised trial

Fundamento. La hipótesis de trabajo fue que la cirugíamínimamente invasiva era superior a la convencionalpara el proceso de artroplastia total de cadera. Paraello se compararon los resultados de la cirugía mínimamenteinvasiva con los de la cirugía convencional enartroplastia total de cadera.Material y métodos. Ensayo clínico prospectivo yaleatorizado. Se seleccionaron 50 pacientes, los cualesfueron divididos en dos grupos en función del abordajequirúrgico: posterior mínimamente invasivo o posteriordirecto convencional. Se evaluaron el sangradoperioperatorio, el dolor postoperatorio, el tiempo de recuperación,la orientación y ajuste de los componentes,la tasa de complicaciones y el resultado funcional y sehan seguido a los pacientes un año mínimo.Resultados. No se han encontrado diferencias significativasentre los grupos en cuanto a sangrado perioperatorio.El dolor postoperatorio fue menor con la cirugíamínimamente invasiva, la velocidad de recuperaciónfue significativamente mayor con el abordaje posteriormínimamente invasivo al detectarse una menor estanciahospitalaria y un inicio más precoz de la deambulación.No se encontraron diferencias en cuanto a tiempoquirúrgico, orientación y ajuste de los componentes,tasa de complicaciones ni resultado funcional. Impactoeconómico favorable a la cirugía mínimamente invasivacon un ahorro del 5% del total de coste del proceso.Conclusiones. El abordaje posterior mínimamente invasivodisminuye el dolor y acelera la recuperación conun impacto económico favorable, sin mostrar diferenciasen ninguna de los demás aspectos estudiados(AU)

Backgrond. Our working hypothesis was that minimallyinvasive surgery was superior to conventionalsurgery for total hip arthroplasty procedure. We comparedTHR results in the minimally invasive posteriorapproach with THR results in the conventional posteriorapproach.Methods. Prospective, randomised trial. Fifty patientswere selected and then divided into two groups basedon treatment (minimally invasive posterior approachor conventional posterior approach). Data collected:Perioperative bleeding, postoperative pain, time ofrecovery, component orientation, complications andfunctional results. One year follow-up.Results. No differences were found in blood loss, surgicaltime, component orientation, rate of complicationsor functional result. The minimally invasive lateralapproach produced less postoperative pain and a fasterrecovery, with a shorter hospital stay and earlierwalking-start, and a positive economic impact with 5%of the total process cost saved.Conclusions. Minimally invasive surgery permits lesspostoperative pain, faster recovery and a positiveeconomic saving, without differences in the rest of theitems studied(AU)

The management of the allergic child at school: EAACI/GA2LEN Task Force on the allergic child at school.

Allergy affects at least one-quarter of European schoolchildren, it reduces quality of life and may impair school performance; there is a risk of severe reactions and, in rare cases, death. Allergy is a multi-system disorder, and children often have several co-existing diseases, i.e. allergic rhinitis, asthma, eczema and food allergy. Severe food allergy reactions may occur for the first time at school, and overall 20% of food allergy reactions occur in schools. Up to two-thirds of schools have at least one child at risk of anaphylaxis but many are poorly prepared. A cooperative partnership between doctors, community and school nurses, school staff, parents and the child is necessary to ensure allergic children are protected. Schools and doctors should adopt a comprehensive approach to allergy training, ensuring that all staff can prevent, recognize and initiate treatment of allergic reactions.