Preoperative coagulation screening tests in pediatric patients: Clinical relevance and hemorrhagic outcomes of abnormal results.

PURPOSE: Coagulation screening tests in children are still frequently performed in many countries to evaluate bleeding risk. The aim of this study was to assess the management of unexpected prolongations of the activated partial thromboplastin time (APTT) and prothrombine time (PT) in children prior to elective surgery, and the perioperative hemorrhagic outcomes. METHODS: Children with prolonged APTT and/or PT who attended a preoperative anesthesia consultation from January 2013 to December 2018 were included. Patients were grouped according to whether they were referred to a Hematologist or were scheduled to undergo surgery without further investigation. The primary endpoint was to compare perioperative bleeding complications. RESULTS: 1835 children were screened for eligibility. 102 presented abnormal results (5.6%). Of them, 45% were referred to a Hematologist. Significant bleeding disorders were associated with a positive bleeding history, odds ratio of 51 (95% CI 4.8-538.5, P=.0011). No difference in perioperative hemorrhagic outcomes were found between the groups. An additional cost of 181 euros per patient and a preoperative median delay of 43 days was observed in patients referred to Hematology. CONCLUSIONS: Our results suggest that hematology referral has limited value in asymptomatic children with a prolonged APTT and/or PT. Hemorrhagic complications were similar among patients referred and not referred to Hematology. A positive personal or family bleeding history can help identify patients with a higher bleeding risk, thus it should guide the need for coagulation testing and hematology referral. Further efforts should be made to standardize preoperative bleeding assessments tools in children.

Pruebas de coagulación preoperatorias en pacientes pediátricos: relevancia clínica y consecuencias hemorrágicas de los resultados anómalos / Preoperative coagulation screening tests in pediatric patients: Clinical relevance and hemorrhagic outcomes of abnormal results

Objetivo: Las pruebas de evaluación de la coagulación en niños siguen realizándose con frecuencia en muchos países, para evaluar el riesgo de hemorragia. El objetivo de este estudio fue valorar el manejo de la prolongación inesperada del tiempo de tromboplastina parcial activada (APTT) y el tiempo de protrombina (PT) en niños previa a la cirugía electiva, y el riesgo hemorrágico perioperatorio. Métodos: Se incluyó a los niños con APTT y/o PT prolongados que acudieron a consulta de anestesia preoperatoria desde enero del 2013 a diciembre del 2018. Se agrupó a los pacientes en función de si habían sido derivados a Hematología o habían sido programados para cirugía sin pruebas adicionales. El resultado primario fue comparar las complicaciones hemorrágicas perioperatorias. Resultados: Se evaluó para elegibilidad a 1.835 niños. Presentaron resultados anormales 102 de ellos (5,6%) y el 45% fue derivado a Hematología previo a la cirugía. Los trastornos hemorrágicos significativos estuvieron asociados a a una historia hemorrágica (personal y/o familiar) positiva, odds ratio de 51 (IC 95% de 4,8 a 538,5, p = 0,0011). No se encontró diferencia en términos de resultados de hemorragia perioperatoria entre los grupos. Se observó un coste adicional de 181 € por paciente y una mediana de demora preoperatoria de 43 días en los pacientes derivados a Hematología. Conclusiones: Nuestros resultados sugieren que la derivación a Hematología tiene un valor limitado en niños asintomáticos con APTT y/o PT prolongados. Las complicaciones hemorrágicas fueron similares entre los pacientes derivados y los no derivados a Hematología. Una historia familiar positiva de hemorragia puede ayudar a identificar a los pacientes con mayor riesgo de sangrado, por lo que debería guiar la petición de los análisis de coagulación y la derivación a Hematología. Esfuerzos adicionales son necesarios para estandarizar las herramientas preoperatorias de evaluación hemorrágica en niños.(AU)

Purpose: Coagulation screening tests in children are still frequently performed in many countries to evaluate bleeding risk. The aim of this study was to assess the management of unexpected prolongations of the activated partial thromboplastin time (APTT) and prothrombine time (PT) in children prior to elective surgery, and the perioperative hemorrhagic outcomes. Methods: Children with prolonged APTT and/or PT who attended a preoperative anesthesia consultation from January 2013 to December 2018 were included. Patients were grouped according to whether they were referred to a Hematologist or were scheduled to undergo surgery without further investigation. The primary endpoint was to compare perioperative bleeding complications. Results: 1835 children were screened for eligibility. 102 presented abnormal results (5.6%). Of them, 45% were referred to a Hematologist. Significant bleeding disorders were associated with a positive bleeding history, odds ratio of 51 (95% CI 4.8 to 538.5, P = 0.0011). No difference in perioperative hemorrhagic outcomes were found between the groups. An additional cost of 181 euros per patient and a preoperative median delay of 43 days was observed in patients referred to Hematology. Conclusions: Our results suggest that hematology referral has limited value in asymptomatic children with a prolonged APTT and/or PT. Hemorrhagic complications were similar among patients referred and not referred to Hematology. A positive personal or family bleeding history can help identify patients with a higher bleeding risk, thus it should guide the need for coagulation testing and hematology referral. Further efforts should be made to standardize preoperative bleeding assessments tools in children.(AU)

Perfil asistencial del paciente con osteoporosis tributario de visita de telemedicina en la era post-COVID-19 / Care profile of susceptible patients with osteoporosis by telemedicine visits in the post-COVID-19 era

Definir el perfil del paciente con osteoporosis candidato y no candidato a la asistencia en la teleconsulta de osteoporosis, en la era post-COVID-19. Propuesta de un protocolo de manejo para su seguimiento ambulatorio. Métodos: Hemos realizado una revisión bibliográfica mediante una búsqueda sistemática en las bases de datos de Pubmed.gov de la evidencia disponible de artículos en inglés y español con fecha de inclusión hasta octubre del 2020 siguiendo las recomendaciones del sistema GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Base de datos cuyo objetivo es la localización y recuperación de información relevante para esta revisión de forma actualizada. Resultados: El perfil del paciente candidato a teleconsulta sería aquel paciente con historia de osteoporosis, que conoce su enfermedad, con tratamiento y que precisa de seguimiento. La COVID-19 se ha dado en un contexto en el que las principales causas de mortalidad son las enfermedades crónicas y la necesidad de protegerse frente a la transmisión. Conclusiones: Proponemos un consenso del manejo de dicho paciente, con apartados diferenciados para las distintas etapas del proceso asistencial telemático, que ayude a la toma de decisiones clínicas y que sirva de ayuda en el proceso de seguimiento y adherencia terapéutica, y, por tanto, en la optimización de recursos asistenciales. (AU)

Objetive: Define the profile of the candidate and non-candidate osteoporosis patient for assistance in osteoporosis teleconsultation, in the post-COVID-19 era. Proposal of a management protocol for outpatient follow-up. Methods: We have carried out a bibliographic review through a systematic search in the Pubmed.gov databases of the available evidence of articles in English and Spanish with an inclusion date until October 2020, following the recommendations of the GRADE system (Grading of Recommendations, Assessment, Development and Evaluation). Database is aimed at locating and accessing relevant information for this review in an updated way. Results: The profile of the patient candidate for teleconsultation would be of those who present a history of osteoporosis, previously diagnosed, with treatment and requiring follow-up. COVID-19 has occurred in a context in which the main causes of mortality are chronic diseases and the need to protect against transmission. Conclusions: We propose a consensus for managing this patient, with differentiated sections for the different stages of the telematic care process. This will help in clinical decision-making and also in the process of follow-up and therapeutic adherence and, therefore, in optimal use of healthcare resources. (AU)

Fluidoterapia de mantenimiento administrada en un hospital terciario: estudio de prevalencia / Maintenance fluid therapy in a tertiary hospital: a prevalence study

Objetivos. Evaluar el tipo de «fluidos/sueros» de mantenimiento administrados en nuestro hospital, y comparar como se ajustan a las recomendaciones actuales, tanto en volumen como en composición. Material y métodos. Estudio observacional y transversal. Se registró el volumen y tipo de fluidoterapia de mantenimiento que se pautaba durante 24h a pacientes ingresados en diferentes servicios del hospital. Se excluyeron aquellos en los que la administración de líquidos estuviese condicionada por un exceso o déficit de líquidos y electrólitos. Resultados. Se recogieron los datos de 198 pacientes, de los cuales 74 (37,4%) fueron excluidos por no cumplir los criterios de inclusión. El volumen medio administrado fue de 2.500cc/día. La dosis media de glucosa fue de 36g cada 24h (DE: 31,4). La combinación más frecuente incluyó suero salino fisiológico (SSF) con glucosado 5% (64,4% de los casos). La cantidad media de sodio administrada en 24h fue de 173mEq (DE: 74,8) y la de cloro de 168mEq (DE: 75), lo que supone superávit de +87,4mEq y +85mEq, respectivamente. En relación con el potasio, magnesio y calcio, el déficit fue de -50mEq, -22mEq y -21mEq día, respectivamente. La administración de sustancias buffer fue excepcional, siendo las más frecuentemente utilizadas el bicarbonato (2,29%), acetato (1,29%), lactato (1,15%) y gluconato (1,10%). Conclusión. El SSF es la solución más frecuentemente utilizada. En contraste con el exceso de sodio y cloro habitualmente pautado, la cantidad de otros iones, como potasio, magnesio, sustancias buffer y aporte calórico, es muy deficitaria (AU)

Objective. To assess the types of maintenance fluids used in our hospital, comparing their volume and composition to the standards recommended by the guidelines. Material and methods. Observational, cross-sectional study. Volume and type of fluid therapy administered during 24h to patients admitted to various hospital departments were recorded. Patients receiving fluid therapy because of water-electrolyte imbalance were excluded. Results. Out of 198 patients registered, 74 (37.4%) were excluded because they did not meet the criteria for inclusion. Mean administered volume was 2,500cc/day. Mean daily glucose dose was 36g per 24h (SD: 31.4). The most frequent combination included normal saline solution (NSS) and glucose 5% (64.4%). Mean daily dose of sodium and chlorine was, respectively, 173mEq (SD: 74.8) and 168mEq (SD: 75), representing a surplus daily dose of +87.4mEq and +85mEq. Potassium, magnesium and calcium daily deficit was, respectively, -50mEq, -22mEq and -21mEq per day. Buffer administration was exceptional, bicarbonate (2.29%), acetate (1.29%), lactate (1.15%) and gluconate (1.10%) being the buffering agents most frequently used. Conclusion. NNS is the most frequently used solution. In contrast to excess doses of sodium and chlorine, there is a great deficit of other ions, buffering agents and caloric intake in the fluid therapy regimens that are usually prescribed (AU)

Maintenance fluid therapy in a tertiary hospital: A prevalence study. / Fluidoterapia de mantenimiento administrada en un hospital terciario: estudio de prevalencia.

OBJECTIVE: To assess the types of maintenance fluids used in our hospital, comparing their volume and composition to the standards recommended by the guidelines. MATERIAL AND METHODS: Observational, cross-sectional study. Volume and type of fluid therapy administered during 24h to patients admitted to various hospital departments were recorded. Patients receiving fluid therapy because of water-electrolyte imbalance were excluded. RESULTS: Out of 198 patients registered, 74 (37.4%) were excluded because they did not meet the criteria for inclusion. Mean administered volume was 2,500cc/day. Mean daily glucose dose was 36g per 24h (SD: 31.4). The most frequent combination included normal saline solution (NSS) and glucose 5% (64.4%). Mean daily dose of sodium and chlorine was, respectively, 173mEq (SD: 74.8) and 168mEq (SD: 75), representing a surplus daily dose of +87.4mEq and +85mEq. Potassium, magnesium and calcium daily deficit was, respectively, -50mEq, -22mEq and -21mEq per day. Buffer administration was exceptional, bicarbonate (2.29%), acetate (1.29%), lactate (1.15%) and gluconate (1.10%) being the buffering agents most frequently used. CONCLUSION: NNS is the most frequently used solution. In contrast to excess doses of sodium and chlorine, there is a great deficit of other ions, buffering agents and caloric intake in the fluid therapy regimens that are usually prescribed.

Metabolismo de la fosfatidilcolina por la microbiota intestinal y riesgo cardiovascular / No disponible

No disponible

Degeneración primaria del cuerpo calloso (Marchiafava-Bignami): 2 formas inusuales de presentación clínica / Primary degeneration of the corpus callosum (Marchiafava-Bignami disease): 2 unusual clinical presentations

No disponible

Granulocytic sarcoma of the breast without development of bone marrow involvement: a case report.

A 29-year-old woman presented with a breast tumor with a primary diagnosis of MALT lymphoma. A repeat biopsy revealed a hematological neoplasm with diffuse, Indian file, and targetoid patterns. The cells were intermediate size with eosinophilic granules; the immunophenotyping showed monocytic differentiation, and no lymphoepithelial lesion was observed. The diagnosis was granulocytic sarcoma. Three different bone marrow biopsies were negative for neoplastic infiltration. After treatment, she developed secondary pancytopenia which contributed to her death 16 months after primary diagnosis. Granulocytic sarcoma of the breast is uncommon. A complete panel of immunohistochemistry is necessary to perform this diagnosis.

Human immunodeficiency virus type 1 Gag-specific vaginal immunity and protection after local immunizations with sindbis virus-based replicon particles.

The majority of human immunodeficiency virus (HIV) infections occur through vaginal and rectal transmission. In seeking a safe, nonreplicating gene-delivery vector that can induce mucosal and systemic immune responses and protection, Sindbis virus-based replicon particles expressing HIV-1 Gag (SIN-Gag) were developed. In mice, after nasal or intramuscular immunization with SIN-Gag and vaginal challenge with vaccinia virus (VV) expressing HIV-1 Gag (VV-Gag), CD8(+) T cell-mediated responses were detected locally, in the vaginal mucosa and in the draining iliac lymph nodes (ILNs), and systemically, in the spleen. However, the mice were not protected against VV-Gag replication in the ovaries. In contrast, after vaginal or rectal immunization with SIN-Gag and vaginal challenge with VV-Gag, despite lower local CD8(+) T cell-mediated responses in the vaginal mucosa and ILNs, the mice were protected against VV-Gag replication in the ovaries. Therefore, local immunization with SIN-Gag induced both local mucosal cell-mediated responses and protection.