Simultaneous nitrogen and dissolved methane removal from an upflow anaerobic sludge blanket reactor effluent using an integrated fixed-film activated sludge system.

One of the main drawbacks of upflow anaerobic sludge blanket (UASB) reactors that treat low-strength sewage at room temperature is related to the low quality of their effluents in terms of dissolved methane, organic matter, and nitrogen content. The present study aims to evaluate the feasibility of using an integrated fixed-film activated sludge (IFAS) system as an alternative post-treatment technology to mitigate the environmental impact of such effluents. For this purpose, a pilot plant composed of a UASB (120 L) followed by an IFAS (66 L) system was operated for 407 days. Special attention was paid to the suspended biomass retention capacity and the dissolved methane and nitrogen removal potential of the IFAS post-treatment system. Furthermore, the role of carriers on denitrification and nitrification processes and the microbial communities present in the biofilm were also analyzed. Average total chemical oxygen demand (CODT) and ammonium removal efficiencies of 92 ± 3% and around 57 ± 16% were attained throughout the entire operation, respectively. During a first period in which biomass was maintained in both biofilms and suspension, and nitrite was the main electron acceptor, maximum nitrogen removal and methane removal efficiencies of 32.5 mg TN L-1 and 93% were observed in the IFAS system, respectively. However, throughout the second period, in which suspended biomass was completely washed out from the IFAS system, and nitrate became the main electron acceptor, these values decreased to 18 ± 4 mg TN Lfeed-1 and 77 ± 12%, respectively. Surprisingly, throughout the entire operation, it was observed that around 50 and 41% of the total nitrogen and methane removals observed in the IFAS system, respectively, were carried out in the aerobic compartment. Aerobic methane oxidizers and anammox were detected with significant relative abundances in the biofilm carriers used in the anoxic and aerobic compartments using 16S rRNA gene amplicon sequencing analysis. Therefore, the use of an IFAS system could be suited to diminish greenhouse gas emissions and nutrients concentration for those sewage treatment plants that used UASB systems, especially in countries with temperate and warm climates.

Minimization of dissolved methane, nitrogen and organic micropollutants emissions of effluents from a methanogenic reactor by using a preanoxic MBR post-treatment system.

The use of a hybrid membrane bioreactor (MBR) post-treatment system is proposed as a cost-efficient technology in order to minimize the environmental impact of anaerobic effluents, treating low-strength sewage at room temperature, such as their high nitrogen content and the presence of dissolved methane. In this research, nitrite was externally added at different concentrations into the anoxic compartment, providing an extra electron acceptor besides the existing nitrate, to evaluate its effect on denitrification, methane oxidation and OMPs removal processes. The nitrite addition significantly improved the denitrification potential of the system, achieving nitrogen removals up to 35 mg TN L-1. Moreover, higher nitrite concentrations clearly promoted an increase in the removal of some organic micropollutants (OMPs) such as diclofenac (DCF), ethinylestradiol (EE2), triclosan (TCS) and ibuprofen (IBP). Nevertheless, methane removal efficiencies or rates were not affected by this fact. Finally, COD and ammonium removals higher than 99 and 91% were observed during the entire operation, respectively. Based on the results, a future strategy in which ammonium is partially oxidized to nitrite could result in better nitrogen and OMPs removals for the proposed technology.

The time response of anaerobic digestion microbiome during an organic loading rate shock.

Knowledge of connections between operational conditions, process stability, and microbial community dynamics is essential to enhance anaerobic digestion (AD) process efficiency and management. In this study, the detailed temporal effects of a sudden glycerol-based organic overloading on the AD microbial community and process imbalance were investigated in two replicate anaerobic digesters by a time-intensive sampling scheme. The microbial community time response to the overloading event was shorter than the shifts of reactor performance parameters. An increase in bacterial community dynamics and in the abundances of several microbial taxa, mainly within the Firmicutes, Tenericutes, and Chloroflexi phyla and Methanoculleus genera, could be detected prior to any shift on the reactor operational parameters. Reactor acidification already started within the first 24 h of the shock and headed the AD process to total inhibition in 72 h alongside with the largest shifts on microbiome, mostly the increase of Anaerosinus sp. and hydrogenotrophic methanogenic Archaea. In sum, this work proved that AD microbial community reacts very quickly to an organic overloading and some shifts occur prior to alterations on the performance parameters. The latter is very interesting as it can be used to improve AD process management protocols.

Proton pump inhibitor-responsive oesophageal eosinophilia correlates with downregulation of eotaxin-3 and Th2 cytokines overexpression.

BACKGROUND: The molecular basis and effects of proton pump inhibitor (PPI) therapy on PPI-responsive oesophageal eosinophilia (PPI-REE) and eosinophilic oesophagitis (EoE) remain unknown. AIM: To compare symptom-histological and cytokine gene expression in PPI-REE and EoE patients, at baseline and after specific treatment. METHODS: In consecutive adult patients with an EoE phenotype (dysphagia/food impaction, typical endoscopic findings and > 15 eos/HPF), gene expression of eotaxin-3, IL-13, and IL-5 were determined in distal and proximal oesophagus, at baseline and after omeprazole 40 mg b.d. for 8 weeks. PPI-REE was defined by clinicohistological response. PPI nonresponders (EoE) were offered treatment with topical steroids. RESULTS: Fifty three patients were re-evaluated on PPI therapy. 23 patients (43%) had PPI-REE and 30 patients (57%) had EoE. At baseline, eotaxin-3/IL-13/IL-5 gene expression was indistinguishable between EoE and PPI-REE, excepting increased IL-5 expression in proximal oesophagus (12.54 vs. 57, P = 0.029). PPI therapy significantly decreased eotaxin-3/IL-13 in PPI-REE, at both oesophageal sites (P ≤ 0.008), and IL-5 in distal (P = 0.016), but not in proximal oesophagus. Patients with steroid-responsive EoE also showed a significant decrease in eotaxin-3/IL-5 expression at both oesophageal sites. In EoE patients, initial PPI trial significantly decreased distal oesophageal eosinophilia (63.78 to 41.79 eos/HPF, P = 0.025) and led to symptom remission in 16%, but did not influence Th2 markers. CONCLUSIONS: Baseline cytokine gene expression in PPI-REE was nearly indistinguishable from EoE. PPI therapy significantly downregulated oesophageal eotaxin-3/Th2-cytokine gene expression in PPI-REE, similarly to that seen in steroid-responsive EoE. A subset of EoE patients showed clinicohistological improvement on PPI therapy.

Variabilidad e idoneidad del tratamiento antimicrobiano de las otitis agudas pediátricas en Asturias / Variability of antibiotic treatment in paediatric acute otitis media in Asturias (Spain)

Introducción: La otitis media aguda (OMA) es la infección bacteriana más común en la edad pediátrica, y la que requiere con más frecuencia prescripción antibiótica. Objetivos: Analizar la variabilidad e idoneidad de los hábitos de prescripción de antimicrobianos en niños diagnosticados de OMA en Asturias. Métodos: Estudio descriptivo, retrospectivo y multicéntrico, que evalúa pacientes pediátricos diagnosticados de OMA en los servicios de urgencias de cinco hospitales asturianos y en las consultas de 80 pediatras de atención primaria. La idoneidad de las prescripciones antibióticas se estableció mediante comparación con estándares de referencia. Resultados: Se recogieron datos de 420 OMA pediátricas, 36,2% en atención primaria y 63,8% en urgencias hospitalarias (5,1% de las consultas pediátricas). Se prescribieron antibióticos en el 89,8% de las OMA. Los antibióticos más pautados fueron amoxicilina (41,4% de los casos que recibieron antibioterapia) y amoxicilina-clavulánico (39,8%). La prescripción antibiótica fue más frecuente en el hospital que en los centros de salud (el 93,7 frente al 82,9%; p <0,01). El tratamiento fue adecuado en el 86,4% de los casos. La idoneidad de la prescripción fue mayor en el hospital (9% inadecuados) que en atención primaria (21,7% inadecuados) (p <0,01), y también cuando la prescripción la realizaban MIR de pediatría (4,4% inadecuados), médicos de familia (6,8% inadecuados) y otros facultativos (10,2% inadecuados) que cuando la realizaban pediatras (19% inadecuados) (p <0,01). Conclusiones: Las OMA suponen el 5% de las consultas pediátricas en nuestro medio y la mayoría reciben tratamiento antibiótico. La antibioterapia pautada es mayoritariamente correcta, aunque la idoneidad es mayor en los casos atendidos en urgencias hospitalarias (AU)

Introduction: Acute otitis media (AOM) is the most frequent bacterian infection in paediatric population and accounts for the largest portion of antibiotic prescriptions in pediatric offices. Objective: The aim of the study was to analyze the variability and appropriateness of antimicrobial prescriptions in children with diagnosis of AOM in emergency departments and pediatric primary care consultations in Asturias (Spain). Methods: Multicenter descriptive study evaluating retrospectively pediatric patients with AOM diagnosis in 5 hospital emergency departments and 80 pediatric primary care clinics in Asturias. Appropriateness of prescription was established by comparing with reference standards. Results: Four hundred twenty cases of AOM (36.2% in primary care and 63.8% in hospital emergency departments) were included (5.1% of pediatric visits). Antibiotics were prescribed in 89.8% of cases. Amoxicillin and amoxicillin/clavulanate were the most frequently prescribed antibiotics (41.4 and 39.8%). Significant differences in the frequency or antibiotic prescription were found between hospital emergency departments and primary care (93.7 vs 82.9%; p <0.01). The prescribed treatment was considered appropriate in 86.4% of cases. The appropriateness of antibiotic prescription was higher in hospitals, and also when prescription was performed by pediatric Internal Medical Resident (4.4% inadequate), family doctors (6.8% inadequate) and other medical doctors (10.2% inadequate), than was performed by pediatricians (19% inadequate) (p <0.01). Conclusions: Acute otitis media acounts for 5% of pediatric visits in our area and most of them are treated with antibiotics, being amoxicillin the most frequently prescribed. Antibiotic therapy is largely correctly prescribed, with the best appropriateness in cases treated in hospital emergency departments (AU)

Hipertricosis cubital o síndrome del codo piloso / Hypertrichosis cubiti (hairy elbow syndrome)

La hipertricosis cubital, o síndrome del codo piloso, es una afección rara, con una repercusión fundamentalmente estética, aunque en la mitad de los casos descritos se ha asociado a otras malformaciones. Se describe el caso de un paciente de 6 años de edad, con un aumento de vello en las superficies extensoras de las extremidades superiores, diagnosticado de hipertricosiscubital. Asimismo, se comentan diferentes aspectos de esta entidad tan poco conocida (AU)

Hypertrichosis cubiti, or hairy elbow syndrome, is a rare disease with fundamentally esthetic repercussion although in half of the described cases other malformations have been associated. We describe the case of a six years old patient with an increase of localized hair in superficial extensors of upper extremities, diagnosed of hypertrichosis cubiti. Different aspects of this little-known syndrome are commented (AU)

Cardiopatías congénitas de detección neonatal en un área sanitaria: experiencia de dos décadas / Congenital heart disease of neonatal detection in a health carea rea: a two decade long experience

Introducción. La incidencia de cardiopatías congénitas ha aumentado en los últimos años, a expensas de las formas más leves. Objetivos. Determinar la incidencia de cardiopatías congénitas de diagnóstico neonatal en un área sanitaria. Comparar los datos demográficos y clínicos con una muestra similar obtenida a principios de los años 90. Material y métodos. Estudio observacional, descriptivo y retrospectivo, de los menores de un mes diagnosticados de cardiopatía congénita entre 2003-2007. Análisis comparativo con una muestra similar recogida en nuestro centro entre 1991-1995. Resultados. Se incluyeron 192 pacientes (17,9 casos/1000 recién nacidos vivos). El motivo de ingreso principal ha sido la sospecha clínica de cardiopatía, seguido de prematuridad. Quince niños precisaron traslado para tratamiento quirúrgico. Los defectos hallados más frecuentes son los de tabiques cardíacos (69,3%) y grandes arterias 811,5%). En el estudio comparativo por quinquenios se observa un aumento significativo de la incidencia de cardiopatías y del uso de la ecocardiografía (de 91% a 98,4%), con una disminución de los traslados (de 28 a 15) y de los fallecimientos (de 11 a 6). Conclusiones. La incidencia de cardiopatías congénitas ha aumentado en nuestra área sanitaria, a expensas fundamentalmente de defectos septales leves (AU)

Introduction. Congenital heart defects frequency have grown in the last years, mainly because of minor defects. Objectives. To establish the incidence of congenital heart defects in a regional hospital. To compare demographic and clinical data with another sample collected at the beginning of the 90´s. Materials and methods. Observational, descriptive and retrospective study of neonates with congenital heart defects form 2003 to 2007. Comparison with data from another sample collected in our hospital from 1991 to 1995. Results. We included 192 cases (17.0/1,000 newborns). The main cause of admission was clinical suspect of a congenital heart defect, followed by preterm babies. Fifteen newborns needed to be transferred to a reference hospital for surgery. The more common congenital heart diseases were: septal defects (69,93%), great arteries defects (11,5%). In the comparative study we have noticed a significant rise in the incidence of congenital heart defects, the use echocardiography, and decreased number of transfers (form 28 to 15) and mortality (from 11 to 6). Conclusions. The incidence of congenital heart defects has risen comparing to the study carried our form 1991 to 1995, mainly due to minor septald effects, with a usually benign prognosis and trend to spontaneous closure (AU)

[Maternal non-diagnosed celiac disease and risk of low birth weight]. / Enfermedad celiaca materna no diagnosticada y riesgo de tener hijos con bajo peso al nacimiento.

AIMS: In order to know the prevalence of celiac disease in mothers with newborns weighing less or more than 2,500 g at birth we carried out a case-control study. PATIENTS: mothers of newborns in Cabueñes Hospital. Case group: Mothers with babies weighing less than 2,500 g at birth. CONTROLS: Mothers with babies weighing more than 2,500 g at birth. One control for each case. METHODS: epidemiological and clinical interviews, and celiac disease serology. RESULTS: We studied 1103 women: 577 cases and 526 controls. We diagnosed 4 celiac disease cases, 2 in the case group and 2 in the control group. These 4 mothers had 3 term newborns (1 case in each 235 mothers; prevalence 0.42%) and 1 preterm newborn (1 case in each 389 mothers; prevalence 0.26%). Two cases had babies with adequate birth weight for their gestational age (1 case in each 419 mothers; prevalence 0.24%) and two cases had babies with low birth weight for their gestational age (1 in each 132 mothers; prevalence 0.75%). The odds ratio for low birth weight was 0.91 (95% CI: 0.12-6.49), the odds ratio for preterm birth was 0.61 (95% CI: 0.06-5.89), ad the odds ratio for low birth weight for gestational age was 3.19 (95% CI: 0.44-22.79). CONCLUSIONS: The prevalence of celiac disease in fertile women in our geographic area was 0.36% (1 case in each 275 mothers), and no differences were found between study groups.

Macroamilasemia en pediatría / Macroamylasemia in paediatrics

No disponible

Enfermedad celiaca materna no diagnosticada y riesgo de tener hijos con bajo peso al nacimiento / No disponible

Objetivo: conocer la prevalencia de enfermedad celiaca enmadres de neonatos mayores y menores de 2.500 gramos depeso al nacimiento.Pacientes: sujetos: casos: madres de neonatos menores de2.500 g al nacimiento. Controles: madres de neonatos mayoresde 2.500 g al nacimiento. Un control por cada caso. Instrumentalización:encuesta clínico-epidemiológica y serología celiaca.Métodos: estudio caso-control. Ámbito: mujeres del Área SanitariaV (Gijón) del Principado de Asturias que den a luz en elHospital de Cabueñes.Resultados: se analizaron 1.103 mujeres: 577 madres de niñosmenores de 2.500 g y 526 madres de niños mayores de 2.500 g.Se diagnosticaron 4 casos de celiaquía, 2 en cada grupo. De las 4madres, 3 dieron a luz a niños a término (1 caso cada 235 madres,prevalencia 0,42%) y 1 dio a luz a un niño prematuro (1 caso cada389 madres, prevalencia 0,26%). Dos madres dieron a luz a niñosde peso adecuado para su edad gestacional (1/419 madres, prevalencia0,24%) y 2 madres dieron a luz niños de bajo peso para suedad gestacional (1/132 madres, prevalencia 0,75%). La odds ratiopara peso menor de 2.500 g al nacimiento fue 0,91 (IC 95% 0,12-6,49), para prematuridad 0,61 (IC 95% 0,06-5,89) y para bajo pesopara su edad gestacional 3,19 (0,44-22,79).Conclusiones: la prevalencia de enfermedad celiaca en mujeresfértiles de Gijón es de un caso cada 275 madres (prevalencia0,36%), sin que hayamos encontrado diferencias entre los dosgrupos estudiados

Aims: in order to know the prevalence of celiac disease inmothers with newborns weighing less or more than 2,500 g atbirth we carried out a case-control study.Patients: mothers of newborns in Cabueñes Hospital. Casegroup: Mothers with babies weighing less than 2,500 g at birth.Controls: Mothers with babies weighing more than 2,500 g atbirth. One control for each case.Methods: epidemiological and clinical interviews, and celiacdisease serology.Results: we studied 1103 women: 577 cases and 526 controls.We diagnosed 4 celiac disease cases, 2 in the case groupand 2 in the control group. These 4 mothers had 3 term newborns(1 case in each 235 mothers; prevalence 0.42%) and 1preterm newborn (1 case in each 389 mothers; prevalence0.26%). Two cases had babies with adequate birth weight for theirgestational age (1 case in each 419 mothers; prevalence 0.24%)and two cases had babies with low birth weight for their gestationalage (1 in each 132 mothers; prevalence 0.75%). The odds ratiofor low birth weight was 0.91 (95% CI: 0.12-6.49), the odds ratiofor preterm birth was 0.61 (95% CI: 0.06-5.89), ad the odds ratiofor low birth weight for gestational age was 3.19 (95% CI: 0.44-22.79).Conclusions: the prevalence of celiac disease in fertilewomen in our geographic area was 0.36% (1 case in each 275mothers), and no differences were found between study groups

[Epidemiological study of juvenile idiopathic arthtitis in the last sixteen years in Asturias (Spain)]. / Estudio epidemiológico de artritis idiopática juvenil en el Principado de Asturias: presentación de la casuística en los últimos dieciséis años.

INTRODUCTION: Juvenile idiopathic arthritis (JIA) is one of the most common chronic diseases in children. The results of several epidemiologic studies have shown surprisingly wide variety in the incidence (0.8 to 22.6 per 100,000 children) and prevalence (7 to 400 per 100,000) of this disease. MATERIAL AND METHODS: We performed a retrospective epidemiological study to identify all patients born after 1989 and resident in Asturias who were diagnosed with JIA using the criteria of the International League of Associations for Rheumatology (ILAR) criteria. RESULTS: Data were obtained from 60 patients (23 boys and 37 girls). The mean age of symptom onset was 5.6 years, with onset of spondyloarthropathies occurring most frequently in the oldest group. An incidence rate of 2.5/10(5) (3.5 at the present time) and a prevalence rate of 51.4/10(5) children and adolescents aged less than 16 years old were calculated. In 50% of patients, JIA started with inflammation in one of the knees. The most frequent form of onset was persistent oligoarticular arthritis (41.7%), followed by spondyloarthropathies (11.7%), conditions that did not meet the criteria for any category (11.7%), polyarticular arthritis (11.7%), systemic disease (10%), psoriatic arthritis (6.7%), and extended oligoarticular arthritis (6.7%). Chronic anterior uveitis was found in 5 patients (pauciarticular group in all 5 patients). Methotrexate was used in 25 children with good response and no relevant adverse events were observed. Only 10% of our patients are currently in the active phase of arthritis. CONCLUSION: An incidence rate of 3.5/10(5) and a prevalence rate of 51.4/10(5) children and adolescents aged less than 16 years old in Asturias were calculated (taking into account the possible bias of our study). The most frequent form of onset was persistent oligoarticular arthritis and the most commonly involved joints were the knees.

Estudio epidemiológico de artritis idiopática juvenil en el Principado de Asturias: presentación de la casuística en los últimos dieciséis años / Epidemiological study of juvenile idiopathic arthtitis in the last sixteen years in Asturias (Spain)

Introducción La artritis idiopática juvenil (AIJ) es una de las enfermedades crónicas más frecuentes en niños. Resulta sorprendente la gran variedad de cifras que manejan los diferentes estudios publicados en cuanto a su incidencia (0,8-22,6/10 5 < de 16 años) y prevalencia (7-400/10 5 jóvenes). Material y métodos Se realiza un estudio epidemiológico retrospectivo de la enfermedad para identificar a todos los enfermos nacidos a partir de 1989, residentes en el Principado de Asturias y diagnosticados de AIJ según los criterios acordados por la Liga Internacional de Asociaciones para la Reumatología (ILAR). Resultados Se obtuvieron datos de un total de 60 pacientes, 23 varones y 37 mujeres. La edad media para el inicio de la enfermedad fue de 5,6 años, siendo las espondiloartropatías las de mayor edad al inicio de la sintomatología. La tasa media de incidencia para todo el período de estudio resultó ser de 2,5/10 5 < 16 años (3,5 en el momento actual). La prevalencia según estos datos sería de 51,4/10 5. En el 50 % de los pacientes la enfermedad se inició como inflamación en una de sus rodillas. En cuanto a la distribución por subgrupos, la mayoría se clasificó como oligoarticular persistente (41,7 %), seguida por las espondiloartropatías (11,7 %), no clasificables (11,7 %), poliarticular (11,7 %), sistémica (10 %), artritis psoriásica (6,7 %) y forma oligoarticular extendida (6,7 %). Se detectaron 5 casos de uveítis anterior crónica (forma oligoarticular en todos los casos). El metotrexato fue empleado en 25 niños, con buena eficacia terapéutica y sin ningún efecto adverso importante. Sólo el 10 % de nuestros pacientes se encuentra actualmente en fase activa de la enfermedad. Conclusiones La incidencia anual de AIJ en Asturias en el momento actual, y con la salvedad de los posibles sesgos de nuestro estudio, es de 3,5/10 5 < 16 años, con una prevalencia de 51,4/10 5 menores de dicha edad. Predomina la forma oligoarticular persistente siendo la rodilla la articulación más frecuentemente afectada

Introduction Juvenile idiopathic arthritis (JIA) is one of the most common chronic diseases in children. The results of several epidemiologic studies have shown surprisingly wide variety in the incidence (0.8 to 22.6 per 100000 children) and prevalence (7 to 400 per 100000) of this disease. Material and methods We performed a retrospective epidemiological study to identify all patients born after 1989 and resident in Asturias who were diagnosed with JIA using the criteria of the International League of Associations for Rheumatology (ILAR) criteria. Results Data were obtained from 60 patients (23 boys and 37 girls). The mean age of symptom onset was 5.6 years, with onset of spondyloarthropathies occurring most frequently in the oldest group. An incidence rate of 2.5/10 5 (3.5 at the present time) and a prevalence rate of 51.4/10 5 children and adolescents aged less than 16 years old were calculated. In 50 % of patients, JIA started with inflammation in one of the knees. The most frequent form of onset was persistent oligoarticular arthritis (41.7 %), followed by spondyloarthropathies (11.7 %), conditions that did not meet the criteria for any category (11.7 %), polyarticular arthritis (11.7 %), systemic disease (10 %), psoriatic arthritis (6.7 %), and extended oligoarticular arthritis (6.7 %). Chronic anterior uveitis was found in 5 patients (pauciarticular group in all 5 patients). Methotrexate was used in 25 children with good response and no relevant adverse events were observed. Only 10 % of our patients are currently in the active phase of arthritis. Conclusion An incidence rate of 3.5/10 5 and a prevalence rate of 51.4/10 5 children and adolescents aged less than 16 years old in Asturias were calculated (taking into account the possible bias of our study). The most frequent form of onset was persistent oligoarticular arthritis and the most commonly involved joints were the knees

Hernia diafragmática congénita en un centro sin ECMO: de la emergencia quirúrgica a la urgencia neonatológica / Congenital diaphragmatic hernia in a center without ECMO: from the surgical to the neonatological emergency

Introducción: Los malos resultados de la hernia diafragmática congénita( HDC) con intervención quirúrgica inmediata propulsaron un cambio en su manejo hacia la estabilización prequirúrgica actual. Aunque el papel de la cirugía retardada parece haber mejorado de forma importante la supervivencia, aún existe controversia en diferentes publicaciones. Pacientes y métodos: Se incluyeron en el estudio todos los pacientesc on HDC ingresados en la unidad de cuidados intensivos neonatales del Hospital Universitario Central de Asturias(centro de tercer nivel sin disponibilidad de oxigenación por membrana extracorpórea) a lo largo de 26 años. Según la pauta de tratamiento se diferenciaron 2 grupos: grupo I (1978-1990)con reparación quirúrgica inmediata (22 pacientes) y grupo II(1991-2003) con estabilización prequirúrgica (27 pacientes). Resultados: Ambos grupos eran comparables respecto a características epidemiológicas y probabilidad de supervivencia deacuerdo a la ecuación propuesta por el Grupo de Estudio de HDC. En el grupo II la medicación sedante, analgésica, relajante muscular e inotrópica fue empleada con más frecuencia (p <0,05),y se encontraron valores preoperatorios significativamente más fisiológicos de pH y PaCO2 menor necesidad de suplementación de oxígeno. La mortalidad fue claramente menor en el grupo II (18,5% en el grupo II frente a un 54,5% en el grupo I, p<,01). Conclusiones: El pronóstico de hernia diafragmática congénita ha mejorado de forma notable en las últimas décadas. La optimización en el tratamiento neonatológico y la estabilización preoperatoria puede ayudar a conseguir altas tasas de supervivencia incluso sin empleo de oxigenación por membrana extracorpórea

The poor outcome associated with immediate surgical repair of congenital diaphragmatic hernia(CDH) led to the current practice of preoperative stabilization. Since the timing of surgery has generated considerable controversy in the literature, we consider it of interest to compare the two approaches to management. Patients and methods: We reviewed the cases of all the infants with CDH admitted over the last 26 years to the neonatal intensive care unit of a tertiary hospital in which extracorporeal membrane oxygenation (ECMO) is not available. They were divided into two groups according to the approach employed: group I (1978-1990), who underwent immediate surgical repair (n=22), and group 11 (1991-2003), who underwent preoperative stabilization (n= 27). Results: The two groups were comparable in terms of the epidemiological characteristics and the probability of survival, according to the equation proposed by the CDH study group. Sedatives, analgesics, muscle relaxants and inotropic agents were administered more frequently in group 11 (p <0.05). The preoperative pH and PaCO2 were significantly closer to physiological levels in group II infants, who algo required less supplemental oxygen. The mortality rate was clearly lower in group 11 (18.5% in group II versus 54.5% in group I, p <0.01). Conclusions: The outcome of CDH has clearly improved over the last decades. The optimization of neonatological management and preoperative stabilization may contribute to the achievement of high survival rates, even without ECMO

[Hypoacusis after the neonatal period. Situations requiring hearing assessment]. / Hipoacusia de detección posneonatal. Circunstancias que precisan evaluación auditiva.

INTRODUCTION: Because hearing plays a major role in language development, pediatric hypoacusis is especially damaging. The high frequency of hearing impairment in newborns and the need for an early diagnosis have led to the establishment of neonatal screening. Nevertheless, there are other situations which may compromise hearing quality in later stages and it is essential to identify them in order to be able to provide early and effective treatment. OBJECTIVES: To describe the most frequent reasons for referring patients for hearing evaluation to a third level hospital and to identify common situations that require hearing assessment among the pediatric population. PATIENTS AND METHODS: The clinical histories of 197 non-neonates evaluated for hypoacusis were reviewed. Clinical parameters and diagnosis were compared in patients with impaired and normal hearing. RESULTS: One hundred sixty-one patients had no previous known hypoacusis. The main reason for evaluation was suspicion by the family or child minder (53.4 %), followed by language underdevelopment. In the first examinations 78 children had hypoacusis (48.4 %), which was more frequently bilateral than unilateral. In 29.5 % of hypoacusic patients, the disease was related to recurrent otitis or adenoiditis and in 25.6 % it was genetic. The most frequent antecedent was deaf relatives in hypoacusic patients and abnormal phenotypes in children with normal hearing. Three patients with previous bacterial meningitis were studied and two of these had hypoacusis. CONCLUSIONS: Hypoacusic evaluation outside the context of newborn screening is mainly motivated by clinical suspicion of hypoacusis or language underdevelopment. Other situations such as recurrent otitis with effusion, syndromic phenotypic characteristics or bacterial meningitis are related to hearing problems and therefore require detailed evaluation.

Hipoacusia de detección posneonatal. Circunstancias que precisan evaluación auditiva / Hypoacusis after the neonatal period. Situations requiring hearing assessment

Introducción: El papel destacado de la audición en el desarrollo del lenguaje verbal hace que la existencia de hipoacusia infantil sea especialmente perniciosa. La elevada frecuencia de defectos de audición presentes en el nacimiento y la necesidad de un reconocimiento precoz han llevado a establecer una detección neonatal. Sin embargo, existen otras situaciones que pueden comprometer la audición en edades más tardías y que es preciso conocer para instaurar las medidas oportunas de forma precoz. Objetivos: Describir los motivos más frecuentes de derivación para estudio de hipoacusia en un hospital de tercer nivel. Dar a conocer situaciones comunes en pediatría con riesgo auditivo en las que es preciso evaluar. Pacientes y métodos: Revisión de las historias de 197 pacientes no neonatos con estudio de hipoacusia. Se compararon parámetros clínicos y diagnósticos en pacientes hipoacúsicos y normooyentes. Resultados: Un total de 161 pacientes no tenían hipoacusia conocida. La principal causa que motivó la evaluación fue la sospecha de hipoacusia por familiares o cuidadores (53,4 %), seguido del retraso del lenguaje. De las primeras consultas, 78 presentaban hipoacusia (48,4 %), más frecuentemente bilateral. En el 29,5 % de los niños con hipoacusia, ésta se atribuyó a otitis o adenoiditis recurrentes y en el 25,6 % a causa genética. La existencia de familiares afectados fue el antecedente más frecuente en hipoacúsicos, mientras que en normooyentes fue la presencia de fenotipo anormal. Se estudiaron tres casos con antecedentes de meningitis bacteriana; en dos de ellos existía defecto auditivo. Conclusiones: Los estudios de hipoacusia fuera de la detección neonatal están motivados, sobre todo, por sospecha clínica de hipoacusia o retraso del lenguaje. Otras situaciones, como las otitis serosas de repetición, presencia de rasgos fenotípicos sindrómicos o las meningitis bacterianas, se relacionan con problemas auditivos y requieren, por tanto, evaluación minuciosa

Introduction: Because hearing plays a major role in language development, pediatric hypoacusis is especially damaging. The high frequency of hearing impairment in newborns and the need for an early diagnosis have led to the establishment of neonatal screening. Nevertheless, there are other situations which may compromise hearing quality in later stages and it is essential to identify them in order to be able to provide early and effective treatment. Objectives: To describe the most frequent reasons for referring patients for hearing evaluation to a third level hospital and to identify common situations that require hearing assessment among the pediatric population. Patients and methods: The clinical histories of 197 non-neonates evaluated for hypoacusis were reviewed. Clinical parameters and diagnosis were compared in patients with impaired and normal hearing. Results: One hundred sixty-one patients had no previous known hypoacusis. The main reason for evaluation was suspicion by the family or child minder (53.4 %), followed by language underdevelopment. In the first examinations 78 children had hypoacusis (48.4 %), which was more frequently bilateral than unilateral. In 29.5 % of hypoacusic patients, the disease was related to recurrent otitis or adenoiditis and in 25.6 % it was genetic. The most frequent antecedent was deaf relatives in hypoacusic patients and abnormal phenotypes in children with normal hearing. Three patients with previous bacterial meningitis were studied and two of these had hypoacusis. Conclusions: Hypoacusic evaluation outside the context of newborn screening is mainly motivated by clinical suspicion of hypoacusis or language underdevelopment. Other situations such as recurrent otitis with effusion, syndromic phenotypic characteristics or bacterial meningitis are related to hearing problems and therefore require detailed evaluation