Impacto de la pandemia en varias enfermedades infecciosas con patrones epidemiológicos distintos de estacionalidad, transmisión y edad / mpact of the pandemic on various infectious diseases with different epidemiological patterns of seasonality, transmission and age

Fundamentos: la pandemia de la covid-19 ha tenido un fuerte impacto sobre otras enfermedades infecciosas. El objetivo de este trabajo fue analizar los cambios epidemiológicos acaecidos durante la pandemia en ocho enfermedades infecciosas con patrones epidemiológicos distintos: la gripe; virus respiratorio sincitial; rotavirus; neumococo; campylobacter; salmonella no tifoidea; gonococia; herpes zóster.métodos: a partir de la red de vigilancia microbiológica, se trazó la serie temporal de casos desde enero de 2017 a marzo de 2023. Se distinguieron tres periodos: prepandemia (referencia), pandemia e inicio de la pospandemia. Se analizó la distribución por edad y sexo en esos periodos. Se calcularon las tasas de incidencia y las razones de tasas (rt). Se estimaron esas rt globales y sus intervalos de confianza al 95% por cada año de edad en menores de cinco años. Resultados: se encontraron diferencias estadísticamente significativas en el impacto que la pandemia tuvo en cada una de esas enfermedades. Algunas, tras un periodo de silencio epidémico, revelaron un repunte intenso pospandémico. Incrementaron la rt global postpandémica la gripe (2,4), vrs (1,9) y gonococia (3,1); recuperó su nivel prepandémico el rotavirus (1,07); y disminuyeron el neumococo (0,84), campylobacter (0,83) y salmonella (0,60). En menores de cinco años, los patrones fueron específicos y hete-rogéneos para cada enfermedad.conclusiones: el impacto de la pandemia es muy diferente en estas enfermedades. Las infecciones víricas estacionales pediá-tricas y de transmisión respiratoria son las que más se ven afectadas, pero con patrones de recuperación de la normalidad distintos. Las infecciones bacterianas gastrointestinales sufren menos variaciones, salvo el rotavirus. La gonococia no interrumpe su tendencia al aumento avistada ya en la prepandemia. El herpes zóster muestra un ligero incremento pospandémico. Se han estudiado varias enfermedades con distinto patrón epidemiológico durante un periodo suficiente para observar cómo se produce la salida de la fase aguda de la pandemia.(AU)

Background: the covid-19 pandemic has had a strong impact on other infectious diseases. The aim of this paper was to analyze the epidemiological changes that occurred during the pandemic in eight infectious diseases with different epidemiological patterns: influenza, respiratory syncytial virus, rotavirus, pneumococcus, campylobacter, non-typhoid salmonella, gonorrhea and herpes zoster.methods: from the microbiological surveillance network, the time series of cases was traced from january 2017 to march 2023. Three periods were distinguished: reference, pandemic and beginning of the post-pandemic. The distribution by age and sex in these periods was analyzed. Incidence rates and rate ratios (rr) were calculated. These rrs and their 95% confidence intervals were estimated overall and by year of age in children under five years of age. Results: statistically significant differences were found in the impact that the pandemic had on each of these diseases. Some, after a period of epidemic silence, have revealed an intense post-pandemic rebound. The post-pandemic global rt increased for influenza (2.4), rsv (1.9) and gonorrhea (3.1); rotavirus recovered its pre-pandemic level (1.07); and pneumococcus (0.84), campylobacter (0.83) and salmonella (0.60) decreased. In children under 5 years of age, the patterns were specific and heterogeneous for each disease.conclusions: the impact of the pandemic is very different in these diseases. Pediatric and respiratory-transmitted seasonal viral infections are the ones that are most affected, but with different patterns of recovery to normality. Gastrointestinal bacterial infections suffer fewer variations, except for rotavirus. Gonorrhea do not interrupt its increasing trend seen in the pre-pandemic. Shingles show a slight post-pandemic increase. Several diseases with different epidemiological patterns have been studied for a sufficient period to observe how the acute phase of the pandemic emerges.(AU)

[Impact of the pandemic on various infectious diseases with different epidemiological patterns of seasonality, transmission and age]. / Impacto de la pandemia en varias enfermedades infecciosas con patrones epidemiológicos distintos de estacionalidad, transmisión y edad.

OBJECTIVE: The COVID-19 pandemic has had a strong impact on other infectious diseases. The aim of this paper was to analyze the epidemiological changes that occurred during the pandemic in eight infectious diseases with different epidemiological patterns: influenza, respiratory syncytial virus, rotavirus, pneumococcus, Campylobacter, non-typhoid Salmonella, gonorrhea and herpes zoster. METHODS: From the Microbiological Surveillance Network, the time series of cases was traced from January 2017 to March 2023. Three periods were distinguished: reference, pandemic and beginning of the post-pandemic. The distribution by age and sex in these periods was analyzed. Incidence rates and rate ratios (RR) were calculated. These RRs and their 95% confidence intervals were estimated overall and by year of age in children under five years of age. RESULTS: Statistically significant differences were found in the impact that the pandemic had on each of these diseases. Some, after a period of epidemic silence, have revealed an intense post-pandemic rebound. The post-pandemic global RT increased for influenza (2.4), RSV (1.9) and gonorrhea (3.1); rotavirus recovered its pre-pandemic level (1.07); and pneumococcus (0.84), Campylobacter (0.83) and Salmonella (0.60) decreased. In children under 5 years of age, the patterns were specific and heterogeneous for each disease. CONCLUSIONS: The impact of the pandemic is very different in these diseases. Pediatric and respiratory-transmitted seasonal viral infections are the ones that are most affected, but with different patterns of recovery to normality. Gastrointestinal bacterial infections suffer fewer variations, except for rotavirus. Gonorrhea do not interrupt its increasing trend seen in the pre-pandemic. Shingles show a slight post-pandemic increase. Several diseases with different epidemiological patterns have been studied for a sufficient period to observe how the acute phase of the pandemic emerges.

OBJECTIVE: La pandemia de la COVID-19 ha tenido un fuerte impacto sobre otras enfermedades infecciosas. El objetivo de este trabajo fue analizar los cambios epidemiológicos acaecidos durante la pandemia en ocho enfermedades infecciosas con patrones epidemiológicos distintos: la gripe; virus respiratorio sincitial; rotavirus; neumococo; Campylobacter; Salmonella no tifoidea; gonococia; herpes zóster. METHODS: A partir de la Red de Vigilancia Microbiológica, se trazó la serie temporal de casos desde enero de 2017 a marzo de 2023. Se distinguieron tres periodos: prepandemia (referencia), pandemia e inicio de la pospandemia. Se analizó la distribución por edad y sexo en esos periodos. Se calcularon las tasas de incidencia y las razones de tasas (RT). Se estimaron esas RT globales y sus intervalos de confianza al 95% por cada año de edad en menores de cinco años. RESULTS: Se encontraron diferencias estadísticamente significativas en el impacto que la pandemia tuvo en cada una de esas enfermedades. Algunas, tras un periodo de silencio epidémico, revelaron un repunte intenso pospandémico. Incrementaron la RT global postpandémica la gripe (2,4), VRS (1,9) y gonococia (3,1); recuperó su nivel prepandémico el rotavirus (1,07); y disminuyeron el neumococo (0,84), Campylobacter (0,83) y Salmonella (0,60). En menores de cinco años, los patrones fueron específicos y heterogéneos para cada enfermedad. CONCLUSIONS: El impacto de la pandemia es muy diferente en estas enfermedades. Las infecciones víricas estacionales pediátricas y de transmisión respiratoria son las que más se ven afectadas, pero con patrones de recuperación de la normalidad distintos. Las infecciones bacterianas gastrointestinales sufren menos variaciones, salvo el rotavirus. La gonococia no interrumpe su tendencia al aumento avistada ya en la prepandemia. El herpes zóster muestra un ligero incremento pospandémico. Se han estudiado varias enfermedades con distinto patrón epidemiológico durante un periodo suficiente para observar cómo se produce la salida de la fase aguda de la pandemia.

Nitrate electro-bioremediation and water disinfection for rural areas.

Nitrate-contaminated groundwater is a pressing issue in rural areas, where up to 40 % of the population lacks access to safely managed drinking water services. The high costs and complexity of centralised treatment in these regions exacerbate this problem. To address this challenge, the present study proposes electro-bioremediation as a more accessible decentralised alternative. Specifically, the main focus of this study is developing and evaluating a compact reactor designed to accomplish simultaneous nitrate removal and groundwater disinfection. Significantly, this study has established a new benchmark for nitrate reduction rate within bioelectrochemical reactors, achieving the maximum reported rate of 5.0 ± 0.3 kg NO3- m-3NCC d-1 at an HRTcat of 0.7 h. Furthermore, thein-situ generation of free chlorine was effective for water disinfection, resulting in a residual concentration of up to 4.4 ± 1.1 mg Cl2 L-1 in the effluent at the same HRTcat of 0.7 h. These achievements enabled the treated water to meet the drinking water standards for nitrogen compounds (nitrate, nitrite, and nitrous oxide) as well as pathogens content (T. coliforms, E. coli, and Enterococcus). In conclusion, this study demonstrates the potential of the electro-bioremediation of nitrate-contaminated groundwater as a decentralised water treatment system in rural areas with a competitive operational cost of 1.05 ± 0.16 € m-3.

Modulating redox properties of solid-state ion-conducting materials using microwave irradiation.

The industrial adoption of low-carbon technologies and renewable electricity requires novel tools for electrifying unitary steps and efficient energy storage, such as the catalytic synthesis of valuable chemical carriers. The recently-discovered use of microwaves as an effective reducing agent of solid materials provides a novel framework to improve this chemical-conversion route, thanks to promoting oxygen-vacancy formation and O2-surface exchange at low temperatures. However, many efforts are still required to boost the redox properties and process efficiency. Here, we scrutinise the dynamics and the physicochemical dependencies governing microwave-induced redox transformations on solid-state ion-conducting materials. The reduction is triggered upon a material-dependent induction temperature, leading to a characteristically abrupt rise in electric conductivity. This work reveals that the released O2 yield strongly depends on the material's composition and can be tuned by controlling the gas-environment composition and the intensity of the microwave power. The reduction effect prevails at the grain surface level and, thus, amplifies for fine-grained materials, and this is ascribed to limitations in oxygen-vacancy diffusion across the grain compared to a microwave-enhanced surface evacuation. The precise cyclability and stability of the redox process will enable multiple applications like gas depuration, energy storage, or hydrogen generation in several industrial applications.

[Guidelines for the management of chronic cough in adults]. / Recommandations de prise en charge de la toux chronique de l'adulte.

Patients with chronic cough experience major alteration in their quality of life. Given its numerous etiologies and treatments, this disease is a complex entity. To help clinicians involved in patient management of patients, guidelines have been issued by a group of French experts. They address definitions of chronic cough and initial management of patients with this pathology. We present herein the second-line tests that might be considered in patients whose coughing has persisted, notwithstanding initial management. The experts have also put forward a definition of unexplained or refractory chronic cough (URCC), the objective being to more precisely identify those patients whose cough persists despite optimal management. Lastly, these guidelines indicate the pharmacological and non-pharmacological interventions of use in URCC. Amitriptyline, pregabalin, gabapentin or morphine combined with speech and/or physical therapy are mainstays in treatment strategies. Other treatment options, such as P2X3 antagonists, are being developed and have generated high hopes among physicians and patients alike.

CO2 in indoor environments: From environmental and health risk to potential renewable carbon source.

In the developed world, individuals spend most of their time indoors. Poor Indoor Air Quality (IAQ) has a wide range of effects on human health. The burden of disease associated with indoor air accounts for millions of premature deaths related to exposure to Indoor Air Pollutants (IAPs). Among them, CO2 is the most common one, and is commonly used as a metric of IAQ. Indoor CO2 concentrations can be significantly higher than outdoors due to human metabolism and activities. Even in presence of ventilation, controlling the CO2 concentration below the Indoor Air Guideline Values (IAGVs) is a challenge, and many indoor environments including schools, offices and transportation exceed the recommended value of 1000 ppmv. This is often accompanied by high concentration of other pollutants, including bio-effluents such as viruses, and the importance of mitigating the transmission of airborne diseases has been highlighted by the COVID-19 pandemic. On the other hand, the relatively high CO2 concentration of indoor environments presents a thermodynamic advantage for direct air capture (DAC) in comparison to atmospheric CO2 concentration. This review aims to describe the issues associated with poor IAQ, and to demonstrate the potential of indoor CO2 DAC to purify indoor air while generating a renewable carbon stream that can replace conventional carbon sources as a building block for chemical production, contributing to the circular economy.

Boosting ethanol production rates from carbon dioxide in MES cells under optimal solventogenic conditions.

Microbial Electrosynthesis (MES) has been widely applied for acetic acid (HA) production from CO2 and electricity. Ethanol (EtOH) has a higher market value than HA, and wide application in industry and as a biofuel. However, it has only been obtained sporadically and at low concentrations, probably due to sub-optimal operating conditions. This study aimed at enhancing EtOH productivity in MES cells by jointly optimising key operation parameters, including pH, H2 and CO2 partial pressure (pH2 and pCO2), and HA concentration, to promote solventogenesis. Two H-type cells were operated in fed-batch mode at -0.8 V vs. SHE with CO2 as the sole carbon source. A mixed culture, enriched with Clostridium ljungdahlii was used as the biocatalyst. The combination of low pH (<4.5) and pCO2 (<0.3 atm), along with high HA concentration (about 6 g L-1) and pH2 (>3 atm), were mandatory conditions for maintaining an efficient solventogenic culture, dominated by Clostridium sp., capable of high-rate EtOH production. The maximum EtOH production rate was 10.95 g m-2 d-1, and a concentration of 5.28 g L-1 was achieved. Up to 30 % of the electrons and 15.2 % of the carbon provided were directed towards EtOH production, and 28.1 kWh were required for the synthesis of 1 kg of EtOH from CO2. These results highlight that strict conditions are required for a continuous, reliable, EtOH production in MES cells. Future investigation should focus on improving cell configuration to achieve EtOH production at higher current densities while minimizing the electric energy input.

Transition roadmap for thermophilic carbon dioxide microbial electrosynthesis: Testing with real exhaust gases and operational control for a scalable design.

Human activities release more carbon dioxide (CO2) into the atmosphere than the natural process can remove. This study attempts to address the main challenges for the thermophilic (50 °C) bioelectrochemical conversion of CO2 into acetate. First, real gaseous emissions were tested with mixed microbial consortia, which had no substantial influence on production rates (difference of 2.5%). Subsequently, a bench-scale system (TRL 4-5) was designed and launched to control key operational variables. Fixing the current at 1.3 A m-2, CO2 was reduced at a rate of 2.21 kg CO2 kg-1 acetate, while the electricity consumption was 2.07 kWh kg-1, the most efficient value so far. The results suggest that the operation with real effluents is feasible and the proposed design is energy efficient, but the right balance between maximising current densities without compromising the biocompatibility with catalysts will determine the transition from laboratory scale towards its implementation in the market.

Effect of hydraulic retention time on the electro-bioremediation of nitrate in saline groundwater.

Bioelectrochemical systems (BES) have proven their capability to treat nitrate-contaminated saline groundwater and simultaneously recover value-added chemicals (such as disinfection products) within a circular economy-based approach. In this study, the effect of the hydraulic retention time (HRT) on nitrate and salinity removal, as well as on free chlorine production, was investigated in a 3-compartment BES working in galvanostatic mode with the perspective of process intensification and future scale-up. Reducing the HRT from 30.1 ± 2.3 to 2.4 ± 0.2 h led to a corresponding increase in nitrate removal rates (from 17 ± 1 up to 131 ± 1 mgNO3--N L-1d-1), although a progressive decrease in desalination efficiency (from 77 ± 13 to 12 ± 2 %) was observed. Nitrate concentration and salinity close to threshold limits indicated by the World Health Organization for drinking water, as well as significant chlorine production were achieved with an HRT of 4.9 ± 0.4 h. At such HRT, specific energy consumption was low (6.8·10-2 ± 0.3·10-2 kWh g-1NO3--Nremoved), considering that the supplied energy supports three processes simultaneously. A logarithmic equation correlated well with nitrate removal rates at the applied HRTs and may be used to predict BES behaviour with different HRTs. The bacterial community of the bio-cathode under galvanostatic mode was dominated by a few populations, including the genera Rhizobium, Bosea, Fontibacter and Gordonia. The results provide useful information for the scale-up of BES treating multi-contaminated groundwater.

Thermodynamic approach to foresee experimental CO2 reduction to organic compounds.

Anaerobic gas fermentation is a promising approach to transform carbon dioxide (CO2) into chemical building blocks. However, the main operational conditions to enhance the process and its selectivity are still unknown. The main objective of this study was to trigger chain elongation from a joint perspective of thermodynamic and experimental assessment. Thermodynamics revealed that acetic acid formation was the most spontaneous reaction, followed by n-caproic and n-butyric acids, while the doorway for alcohols production was bounded by the selected conditions. Best parameters combinations were applied in three 0.12 L fermenters. Experimentally, n-caproic acid formation was boosted at pH 7, 37 °C, Acetate:Ethanol mass ratio of 1:3 and low H2 partial pressure. Though these conditions did not match with those required to produce their main substrates, the unification of both perspectives yielded the highest n-caproic acid concentration (>11 g L-1) so far from simple substrates, accounting for 77 % of the total products.

Electrochemical water softening as pretreatment for nitrate electro bioremediation.

Electro bioremediation is gaining interest as a sustainable treatment for contaminated groundwater. Nevertheless, the investigation is still at the laboratory level, and before their implementation is necessary to overcome important drawbacks. A prevalent issue is the high groundwater hardness that generates scale deposition on electrodes that irreversibly affects the treatment effectiveness and their lifetime. For this reason, the present study evaluated a novel and sustainable approach combining electrochemical water softening as a preliminary step for electro bioremediation of nitrate-contaminated groundwater. Batch mode tests were performed at mL-scale to determine the optimum reactor configuration (single- or two-chambers) and the suitable applied cathode potential for electrochemical softening. A single-chamber reactor working at a cathode potential of -1.2 V vs. Ag/AgCl was chosen. Continuous groundwater softening under this configuration achieved a hardness removal efficiency of 64 ± 4% at a rate of 305 ± 17 mg CaCO3 m-2cathode h-1. The saturation index at the effluent of the main minerals susceptible to precipitate (aragonite, calcite, and brucite) was reduced up to 90%. Softening activity plummeted after 13 days of operation due to precipitate deposition (mostly calcite) on the cathode surface. Polarity reversal periods were considered to detach the precipitated throughout the continuous operation. Their implementation every 3-4 days increased the softening lifetime by 48%, keeping a stable hardness removal efficiency. The nitrate content of softened groundwater was removed in an electro bioremediation system at a rate of 1269 ± 30 g NO3- m-3NCC d-1 (97% nitrate removal efficiency). The energy consumption of the integrated system (1.4 kWh m-3treated) confirmed the competitiveness of the combined treatment and paves the ground for scaling up the process.

LUCAS (lung ultrasonography in cardiac surgery) score to monitor pulmonary edema after congenital cardiac surgery in children.

AIM: Cardiopulmonary bypass (CPB) generates a systemic capillary leak syndrome with pulmonary edema. Lung ultrasound (LUS) could be useful to monitor it. Primary objective was to compare sensitivity, specificity, positive and negative predictive values of chest X-ray and LUS to detect pulmonary edema using a new score (LUCAS). Secondary objectives were to evaluate correlation between LUCAS score and respiratory and inotropic support. METHODS: Prospective intervention study including patients <2 months admitted to the Pediatric Intensive Care Unit after CPB. LUS was performed with a lineal probe, screening 3 points in each lung (parasternal, anterolateral and posterior area), pre and post-CPB. Pulmonary edema was evaluated clinically, through LUCAS score and with X-ray. RESULTS: 17 patients were included. LUS achieved higher sensitivity than X-ray to detect pulmonary edema (91.7 versus 44.0%) and greater predictive negative value (88.2 versus 53.3%). There was correlation between higher LUCAS score prior to surgery and longer mechanical ventilation. High values of LUCAS score after surgery correlated with longer CPB time, inotropic support, and FiO2 need. CONCLUSION: LUS detected pulmonary edema better than chest X-ray, with greater sensitivity and negative predictive value. LUCAS score was useful to predict more inotropic support and longer mechanical ventilation.Key notesCardiopulmonary bypass during cardiac surgery, generates a systemic capillary leak syndrome with pulmonary edema.In this prospective study performed in the Pediatric Intensive Care Unit, lung ultrasound detected pulmonary edema better than X-ray, with greater sensitivity and negative predictive value.LUCAS score was useful to predict more inotropic support and longer mechanical ventilation.

Combining electro-bioremediation of nitrate in saline groundwater with concomitant chlorine production.

Groundwater pollution and salinization have increased steadily over the years. As the balance between water demand and availability has reached a critical level in many world regions, a sustainable approach for the management (including recovery) of saline water resources has become essential. A 3-compartment cell configuration was tested for a new application based on the simultaneous denitrification and desalination of nitrate-contaminated saline groundwater and the recovery of value-added chemicals. The cells were initially operated in potentiostatic mode to promote autotrophic denitrification at the bio-cathode, and then switched to galvanostatic mode to improve the desalination of groundwater in the central compartment. The average nitrate removal rate achieved was 39±1 mgNO3--N L-1 d-1, and no intermediates (i.e., nitrite and nitrous oxide) were observed in the effluent. Groundwater salinity was considerably reduced (average chloride removal was 63±5%). Within a circular economy approach, part of the removed chloride was recovered in the anodic compartment and converted into chlorine, which reached a concentration of 26.8±3.4 mgCl2 L-1. The accumulated chlorine represents a value-added product, which could also be dosed for disinfection in water treatment plants. With this cell configuration, WHO and European legislation threshold limits for nitrate (11.3 mgNO3--N L-1) and salinity (2.5 mS cm-1) in drinking water were met, with low specific power consumptions (0.13±0.01 kWh g-1NO3--Nremoved). These results are promising and pave the ground for successfully developing a sustainable technology to tackle an urgent environmental issue.

Impacto de una modificación de la guía de práctica clínica de la Academia Americana de Pediatría en el manejo de la bronquiolitis aguda grave en una unidad de cuidados intensivos pediátricos / Impact of a modification of the clinical practice guide of the American Academy of Pediatrics in the management of severe acute bronchiolitis in a pediatric intensive care unit

Objetivo: Describir las características y la evolución de los pacientes con bronquiolitis ingresados en una unidad de cuidados intensivos pediátricos. Comparar el tratamiento administrado pre y pospublicación de la guía de práctica clínica de la Academia Americana de Pediatría. Diseño: Estudio descriptivo y observacional realizado entre septiembre de 2010 y septiembre de 2017. Configuración: Unidad de cuidados intensivos pediátricos. Pacientes: Menores de un año con bronquiolitis grave. Intervenciones: Se compararon 2 períodos (2010-14 y 2015-17), antes y después de la modificación del protocolo de manejo de la bronquiolitis en el hospital, según las guías de la Academia Americana de Pediatría. Principales variables: Sexo, edad, comorbilidades, gravedad, etiología, tratamiento administrado, infecciones bacterianas, soporte respiratorio e inotrópico, estancia y mortalidad. Resultados: Se recogieron 706 pacientes, 414 (58,6%) varones, con una mediana de edad de 47 días (RIC 25-100,25). Mediana de escala de gravedad de bronquiolitis (BROSJOD) al ingreso: 9 puntos (RIC 7-11). La etiología por virus respiratorio sincitial se dio en 460 (65,16%) pacientes. El primer período (2010-14) incluyó 340 pacientes y el segundo (2015-17), 366 pacientes. En el segundo período se administraron más nebulizaciones de adrenalina y suero salino hipertónico, y más tratamiento con corticoides. Se usó más ventilación no invasiva y menos ventilación mecánica convencional y precisaron menos soporte inotrópico, sin diferencias significativas. La tasa de antibioterapia disminuyó de forma estadísticamente significativa (p = 0,003). Conclusiones: Pese a la disminución en la antibioterapia, se debería limitar la utilización de nebulizaciones y corticoides en estos pacientes, como recomienda la guía

Objective: To describe the characteristics and evolution of patients with bronchiolitis admitted to a pediatric intensive care unit, and compare treatment pre- and post-publication of the American Academy of Pediatrics clinical practice guide. Design: A descriptive and observational study was carried out between September 2010 and September 2017. Setting: Pediatric intensive care unit. Patients: Infants under one year of age with severe bronchiolitis. Interventions: Two periods were compared (2010-14 and 2015-17), corresponding to before and after modification of the American Academy of Pediatrics guidelines for the management of bronchiolitis in hospital. Main variables: Patient sex, age, comorbidities, severity, etiology, administered treatment, bacterial infections, respiratory and inotropic support, length of stay and mortality. Results: A total of 706 patients were enrolled, of which 414 (58.6%) males, with a median age of 47 days (IQR 25-100.25). Median bronchiolitis severity score (BROSJOD) upon admission: 9 points (IQR 7-11). Respiratory syncytial virus appeared in 460 (65.16%) patients. The first period (2010-14) included 340 patients and the second period (2015-17) 366 patients. More adrenalin and hypertonic saline nebulizations and more corticosteroid treatment were administered in the second period. More noninvasive ventilation and less conventional mechanical ventilation were used, and less inotropic support was needed, with no significant differences. The antibiotherapy rate decreased significantly (P = .003). Conclusions: Despite the decrease in antibiotherapy, the use of nebulizations and glucocorticoids in these patients should be limited, as recommended by the guide

Impact of a modification of the clinical practice guide of the American Academy of Pediatrics in the management of severe acute bronchiolitis in a pediatric intensive care unit.

OBJECTIVE: To describe the characteristics and evolution of patients with bronchiolitis admitted to a pediatric intensive care unit, and compare treatment pre- and post-publication of the American Academy of Pediatrics clinical practice guide. DESIGN: A descriptive and observational study was carried out between September 2010 and September 2017. SETTING: Pediatric intensive care unit. PATIENTS: Infants under one year of age with severe bronchiolitis. INTERVENTIONS: Two periods were compared (2010-14 and 2015-17), corresponding to before and after modification of the American Academy of Pediatrics guidelines for the management of bronchiolitis in hospital. MAIN VARIABLES: Patient sex, age, comorbidities, severity, etiology, administered treatment, bacterial infections, respiratory and inotropic support, length of stay and mortality. RESULTS: A total of 706 patients were enrolled, of which 414 (58.6%) males, with a median age of 47 days (IQR 25-100.25). Median bronchiolitis severity score (BROSJOD) upon admission: 9 points (IQR 7-11). Respiratory syncytial virus appeared in 460 (65.16%) patients. The first period (2010-14) included 340 patients and the second period (2015-17) 366 patients. More adrenalin and hypertonic saline nebulizations and more corticosteroid treatment were administered in the second period. More noninvasive ventilation and less conventional mechanical ventilation were used, and less inotropic support was needed, with no significant differences. The antibiotherapy rate decreased significantly (p=0.003). CONCLUSIONS: Despite the decrease in antibiotherapy, the use of nebulizations and glucocorticoids in these patients should be limited, as recommended by the guide.

Impact of a modification of the clinical practice guide of the American Academy of Pediatrics in the management of severe acute bronchiolitis in a pediatric intensive care unit. / Impacto de una modificación de la guía de práctica clínica de la Academia Americana de Pediatría en el manejo de la bronquiolitis aguda grave en una unidad de cuidados intensivos pediátricos.

OBJECTIVE: To describe the characteristics and evolution of patients with bronchiolitis admitted to a pediatric intensive care unit, and compare treatment pre- and post-publication of the American Academy of Pediatrics clinical practice guide. DESIGN: A descriptive and observational study was carried out between September 2010 and September 2017. SETTING: Pediatric intensive care unit. PATIENTS: Infants under one year of age with severe bronchiolitis. INTERVENTIONS: Two periods were compared (2010-14 and 2015-17), corresponding to before and after modification of the American Academy of Pediatrics guidelines for the management of bronchiolitis in hospital. MAIN VARIABLES: Patient sex, age, comorbidities, severity, etiology, administered treatment, bacterial infections, respiratory and inotropic support, length of stay and mortality. RESULTS: A total of 706 patients were enrolled, of which 414 (58.6%) males, with a median age of 47 days (IQR 25-100.25). Median bronchiolitis severity score (BROSJOD) upon admission: 9 points (IQR 7-11). Respiratory syncytial virus appeared in 460 (65.16%) patients. The first period (2010-14) included 340 patients and the second period (2015-17) 366 patients. More adrenalin and hypertonic saline nebulizations and more corticosteroid treatment were administered in the second period. More noninvasive ventilation and less conventional mechanical ventilation were used, and less inotropic support was needed, with no significant differences. The antibiotherapy rate decreased significantly (P=.003). CONCLUSIONS: Despite the decrease in antibiotherapy, the use of nebulizations and glucocorticoids in these patients should be limited, as recommended by the guide.