Fallo ovárico, una problemática para las mujeres en edad reproductiva y su relación genética / Ovarian failure, a problem for women in reproductive age and its genetic relationship

La insuficiencia ovárica primaria es una condición en la que las mujeres menores de 40años experimentan oligomenorrea o amenorrea durante 4meses o más; esta pérdida temprana de la función ovárica puede estar relacionada con una serie de etiologías, incluidos trastornos genéticos, autoinmunes, infecciones o causas iatrogénicas; no obstante, del 74 al 90% son idiopáticas. A pesar de ser una alteración poco prevalente, es de gran importancia clínica, ya que afecta en múltiples aspectos de la vida a todas las mujeres. En la actualidad se están desarrollando diferentes estudios con el fin de encontrar nuevos blancos moleculares para establecer nuevas terapias para el tratamiento de esta patología.(AU)

Primary ovarian failure is a condition in which women under 40 experience oligomenorrhea or amenorrhea for 4months or longer; this early ovarian function loss may be related to a series of etiologies, including genetic disorders, autoimmune diseases, infections or iatrogenic causes; however 74%-90% are idiopathic. Despite being a less prevalent disorder, it is of great clinical importance since it affects all women in multiple aspects of life. At present, different studies are being developed in order to find new molecular targets to establish new therapies for the treatment of this pathology.(AU)

MicroARN: la biología molecular como herramienta de predicción en preeclampsia / MicroRNAs: molecular biology as a tool for preeclampsia prediction

La preeclampsia es una patología con una importante incidencia a nivel mundial que se encuentra asociada directamente con el 15% de las muertes maternas. Esta se caracteriza usualmente por la presencia de hipertensión y proteinuria, que se manifiestan desde la mitad de la gestación. Los microARN son moléculas de ARN monocatenario que actúan principalmente degradando el ARN mensajero transcrito o inhibiendo la traducción de microARN. Los microARN placentarios ejercen un papel en el crecimiento y función de la placenta, se considera factible su uso potencial como biomarcadores de diagnóstico debido a la capacidad de entrar en la circulación materna y ser detectables en el plasma materno.

Preeclampsia is a disease with a significant incidence worldwide that is directly associated with 15% of maternal deaths. This is usually characterized by the presence of hypertension and proteinuria, which manifests itself from the middle of pregnancy. MicroRNAs are single-stranded RNA molecules that act primarily by degrading transcribed messenger RNA or inhibiting microRNA translation. Placental microRNAs play a role in the growth and function of the placenta, their potential use as diagnostic biomarkers is considered feasible due to the ability to enter the maternal circulation and be detectable in maternal plasma.

End-of-life transfusions in patientswith an oncological diagnosis / Transfusiones al final de la vida en pacientes con diagnóstico oncológico

Introduction: Cancer patients in terminal stages present symptoms related to anemia, other cytopenias, and coagulopathies that deteriorate the quality of life. These symptoms can be multicausal and do not improve in most cases. Objective: Describe the use of blood transfusions in the six months before death as an alternative palliative treatment in patients with an oncological diagnosis in the city of Medellin during the period 2013-2018. Methods: Retrospective cohort, in patients with a cancer diagnosis who received transfusions in the last six months of life, a non-probabilistic sampling of consecutive cases was executed. The analysis was carried out in SPSS, estimating absolute and relative frequencies and median with interquartile ranges. Results: Out of 3,254 medical records of cancer pa­tients, 151 were included. The time to oncological diagnosis had a median of 2 years (IQR 1 and 3). The symptoms observed in patients before and after the first transfusion were pain, present in 32.1 % (46) and 16.9 % (25) respectively, besides drowsiness was distinguished in 25 % (36) before transfusion and 14.3 % (21) after. Finally, the clinical outcomes before and after the last transfusion prior to death, were a decrease in pain, asthenia/adynamia, drowsiness, among others. Conclusions: The findings of this research allow us to appreciate the current panorama in the institutions in which palliative care medical services are being provided and consider when to offer the blood products to a patient at the end of life as a therapeutic measure in the context of a human being cared by physicians.(AU)

Introducción: Los pacientes con cáncer en fase terminal presentan síntomas relacionados con la anemia, otras citopenias y coagulopatías que deterioran la calidad de vida. Estos síntomas pueden ser multicausales y no mejoran en la mayoría de los casos. Objetivo: Describir el uso de transfusiones sanguíneas en los seis meses previos a la muerte como alternativa de tratamiento paliativo en pacientes con diagnóstico oncológico en la ciudad de Medellín durante el periodo 2013-2018. Métodos: Cohorte retrospectiva, en pacientes con diagnóstico de cáncer que recibieron transfusiones en los últimos seis meses de vida, se ejecutó un muestreo no probabilístico de casos consecutivos. El análisis se realizó en SPSS, estimando frecuencias absolutas y relativas y mediana con rangos intercuartílicos.Resultados: De 3254 historias clínicas de pacientes con cáncer, 151 fueron incluidas. El tiempo hasta el diagnóstico oncológico tuvo una mediana de 2 años (IQR 1 y 3). Los síntomas observados en los pacientes antes y después de la primera transfusión fueron el dolor, presente en el 32,1 % (46) y el 16,9 % (25) respectivamente, además de la somnolencia que se distinguió en el 25 % (36) antes de la transfusión y el 14,3 % (21) después. Finalmente, los resultados clínicos antes y después de la última transfusión antes de la muerte, fueron una disminución del dolor, astenia/adinamia, somnolencia, entre otros. Conclusiones: Los hallazgos de esta investigación permiten apreciar el panorama actual en las instituciones en las que se prestan servicios médicos de cuidados paliativos y considerar cuándo ofrecer los hemoderivados a un paciente al final de la vida como medida terapéutica en el contexto de un ser humano atendido por los médicos.(AU)

[Vascular injury associated with knee dislocation]. / La lesión vascular asociada a la luxación de rodilla.

INTRODUCTION: Knee dislocation is a rare injury but considered serious clinically since it can be accompanied by vascular and neurological injuries that if they do not have a timely diagnosis and treatment can lead to the loss of the limb. Regarding vascular injury, the optimal diagnostic method for the identification of this type of lesion is of the utmost importance. OBJECTIVE: To present the literature review on the epidemiology, classification and diagnostic approach of knee dislocation with or without associated vascular injury. METHODS: Report of the literature found in databases and analyses based on clinical experience and synthesis of these documents. CONCLUSION: Vascular injury is not an uncommon finding in the context of knee dislocation, with a high risk of complications and even amputation if an early diagnosis is not made, the authors recommend angio-CT to confirm the suspected diagnosis and not delay treatment.

INTRODUCCIÓN: La luxación de rodilla es una lesión poco común, pero considerada grave clínicamente, ya que puede acompañarse de lesiones vasculares y neurológicas que si no tienen un diagnóstico y tratamiento oportuno pueden llegar a la pérdida de la extremidad. Respecto a la lesión vascular es de suma importancia el método diagnóstico óptimo para la identificación de este tipo de lesiones. OBJETIVO: Presentar la revisión bibliográfica sobre la epidemiología, clasificación y aproximación diagnóstica de la luxación de rodilla con o sin lesión vascular asociada. MÉTODOS: Reporte de la literatura encontrada en bases de datos y análisis basados en experiencia clínica y síntesis de estos documentos. CONCLUSIÓN: La lesión vascular no es un hallazgo infrecuente en el contexto de una luxación de rodilla, tiene un riesgo elevado de complicaciones e incluso de amputación si no se realiza un diagnóstico temprano, los autores recomiendan la angio-TAC para confirmar la sospecha diagnóstica y no retrasar el tratamiento.

Transfusiones al final de la vida. Revisión de algunas consideraciones importantes / Transfusions at the end of life. Review of some important considerations

La trasfusión de hemoderivados se utiliza con más frecuencia en pacientes con neoplasias hematológicas que en pacientes con tumores sólidos, y de forma variable en el caso de pacientes terminales con otro tipo de patologías. La anemia y trombocitopenia son frecuentes en este grupo diverso de pacientes, que reciben tratamientos hasta el final de la vida, siendo la transfusión de componentes sanguíneos, como los glóbulos rojos o las plaquetas, una intervención necesaria para el alivio de síntomas y mejoras en el estado clínico. Sin embargo, en pacientes con enfermedad terminal, los síntomas son de origen multifactorial y los valores hematológicos no necesariamente se convierte en un criterio para transfundir. No obstante, la evidencia científica que apoya que las transfusiones mejoren significativamente los síntomas de los pacientes paliativos aún no es concluyente.A pesar de que la literatura define algunas indicaciones para transfundir las dificultades, empiezan en el contexto de la selección del tipo de transfusión, la cantidad de las mismas y el fin de vida. En la literatura científica se encuentran diferentes comunicaciones que relacionan las últimas unidades de hemoderivados administrados, previo a la muerte del paciente; sin embargo, poco se encuentra con relación a criterios uniformes que apoyen la decisión al final de la vida y la relación riesgo beneficio no es clara.Las trasfusiones sanguíneas, además de ser procedimientos comunes en la práctica clínica, son terapias que generan riesgos y costes considerables para el sistema, por lo que la búsqueda de opciones alternas se hace imperativo a la hora de evitar terapias innecesarias.(AU)

Transfusion of blood products is used more frequently in patients with hematological malignancies than in patients with solid tumors, and variably in the case of terminally ill patients with other types of pathologies. Anemia and thrombocytopenia are frequent in this diverse group of patients, who receive treatments until the end of life, the transfusion of blood components, such as red blood cells or platelets, being a necessary intervention for the relief of symptoms and improvements in condition. clinical. However, in terminally ill patients, symptoms are multifactorial in origin and hematological values do not necessarily become a criterion for transfusing, however, the scientific evidence supporting that transfusions significantly improve the symptoms of palliative patients has not yet is conclusive.Although the literature defines some indications for transfusing difficulties, they begin in the context of the selection of the type of transfusion, the amount of the transfusion, and the end of life. In the scientific literature there are different reports that list the last units of blood products administered, prior to the death of the patient; however, little is found in relation to uniform criteria that support the decision at the end of life and the risk benefit ratio is not clear.Blood transfusions, in addition to being common procedures in clinical practice, are therapies that generate considerable risks and costs for the system, so the search for alternative options becomes imperative when it comes to avoiding unnecessary therapies.Patients with end-of-life transfusion needs generally have a history of known chronic disease; It is for this reason that the mobilization of individual and family resources becomes the challenge for healthcare personnel, since this will largely depend on the way in which the situation is dealt with and the links that are generated, so the approach must be carried out in an interdisciplinary way.(AU)

Mordedura de serpientes venenosas: experiencia durante 5 años / Moisonous snakebites: a five-year experience

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Tóxicos vegetales: un problema aún vigente / Poisonous plants: An ongoing problema

INTRODUCCIÓN: La consulta por ingesta de plantas es poco habitual en los Servicios de Urgencias pediátricas pero puede conllevar una elevada toxicidad. La formación sobre toxicología botánica del personal sanitario suele ser escasa y puede resultar difícil llegar al diagnóstico o establecer el tratamiento adecuado. OBJETIVO: Estudiar las características epidemiológicas y clínicas de las intoxicaciones por ingesta de sustancias vegetales con el fin de aumentar su conocimiento en el personal sanitario. MATERIALES Y MÉTODOS: Estudio descriptivo retrospectivo de los pacientes atendidos por ingesta de sustancia vegetal, entre enero del 2008 y diciembre del 2012, en el Servicio de Urgencias de un hospital materno-infantil de tercer nivel. RESULTADOS: Durante el periodo de estudio fueron atendidos 18 pacientes con ingesta de un posible tóxico vegetal. En 14 casos la ingesta se consideró potencialmente tóxica: retama, adelfa, muérdago, acebillo, judía vulgar (2), tomate de Jerusalén, ricino (2), estramonio, potus, marihuana y setas con toxicidad digestiva (2). De estos, en 10 la ingesta fue no intencionada, 2 casos pueden enmarcarse en el maltrato infantil, se produjo un caso con fin recreativo y otro con fin suicida. Destacaron por su toxicidad las ingestas de adelfa, ricino y estramonio. CONCLUSIONES: La potencial gravedad de la ingesta de sustancias vegetales y la variedad de los mecanismos de exposición al tóxico obligan al pediatra a tener presente esta posibilidad y estar preparado para su diagnóstico y manejo. Es necesario diseñar medidas preventivas específicas, como la información a las familias o la regulación de la presencia de plantas tóxicas en zonas de recreo

INTRODUCTION: A medical visit for plant ingestion is rare in the pediatric emergency services but may involve a high toxicity. The botanical toxicology training of health staff is often very limited, and it can be difficult to make a diagnosis or decide on the appropriate treatment. OBJECTIVE: To study the epidemiological and clinical characteristics of poisoning due to plant ingestion in order to increase the knowledge of the health professional. MATERIAL AND METHODS: A descriptive retrospective study was conducted on patients seen in a pediatric emergency department after the ingestion of plant substances from January 2008 to December 2012. RESULTS: During the period of study, 18 patients had ingested possible toxic plants. In 14 cases, it was considered to be potentially toxic: broom, oleander, mistletoe, butcher's-broom, and vulgar bean (2), Jerusalem tomato, castor (2), Jimson weed, potus, marijuana, and mushrooms with digestive toxicity (2). Among the potentially toxic cases, the ingestion was accidental in 10 patients, 2 cases were classed as infantile mistreatment, 1 case had recreational intention, and another one suicidal intentions. The ingestion of oleander, castor and Jimson weed had major toxicity. CONCLUSIONS: The potential gravity of the ingestion of plant substances and the variety of the exposure mechanism requires the pediatrician to bear in mind this possibility, and to be prepared for its diagnosis and management. Specific preventive information measures need to be designed for the families and for the regulation of toxic plants in playgrounds

[Poisonous plants: An ongoing problem]. / Tóxicos vegetales: un problema aún vigente.

INTRODUCTION: A medical visit for plant ingestion is rare in the pediatric emergency services but may involve a high toxicity. The botanical toxicology training of health staff is often very limited, and it can be difficult to make a diagnosis or decide on the appropriate treatment. OBJECTIVE: To study the epidemiological and clinical characteristics of poisoning due to plant ingestion in order to increase the knowledge of the health professional. MATERIAL AND METHODS: A descriptive retrospective study was conducted on patients seen in a pediatric emergency department after the ingestion of plant substances from January 2008 to December 2012. RESULTS: During the period of study, 18 patients had ingested possible toxic plants. In 14 cases, it was considered to be potentially toxic: broom, oleander, mistletoe, butcher's-broom, and vulgar bean (2), Jerusalem tomato, castor (2), Jimson weed, potus, marijuana, and mushrooms with digestive toxicity (2). Among the potentially toxic cases, the ingestion was accidental in 10 patients, 2 cases were classed as infantile mistreatment, 1 case had recreational intention, and another one suicidal intentions. The ingestion of oleander, castor and Jimson weed had major toxicity. CONCLUSIONS: The potential gravity of the ingestion of plant substances and the variety of the exposure mechanism requires the pediatrician to bear in mind this possibility, and to be prepared for its diagnosis and management. Specific preventive information measures need to be designed for the families and for the regulation of toxic plants in playgrounds.

Uso de antídotos en un servicio de urgencias pediátricas / Antidote use in a pediatric emergency department

INTRODUCCIÓN: La intoxicación es un motivo de consulta poco frecuente en un servicio de urgencias pediátricas (SUP) pero potencialmente grave. Conviene que el pediatra conozca el uso adecuado de los antídotos disponibles. OBJETIVOS: Analizar el uso de antídotos en un SUP y evaluar la idoneidad de su indicación. MATERIALES Y MÉTODOS: Estudio retrospectivo de los pacientes que consultaron, entre enero del 2008 y junio del 2012, por sospecha de intoxicación por una sustancia para la cual existe antídoto. La evaluación de la idoneidad de la indicación del antídoto se basó en las recomendaciones de la Sociedad Española de Urgencias de Pediatría. RESULTADOS: Se recogieron 1.728 consultas por sospecha de intoxicación (0,4% de las visitas). En 353 (20,4%) el tóxico implicado podía ser tratado con un antídoto. Recibieron antídoto 67 pacientes (3,9% de las consultas por sospecha de intoxicación) y se realizaron en total 69 administraciones de antídoto: oxígeno 100% (46), N-acetilcisteína (10), flumazenilo (4), naloxona (3), desferroxamina (2), vitamina K (2), bicarbonato (1) y carnitina (1). En 3 casos no existía indicación del antídoto: flumazenilo sin depresión respiratoria (2) y vitamina K tras exposición a cumarínico (1). Como efecto secundario se objetivó agitación psicomotriz tras uso de flumazenilo y disminución del tiempo de protrombina durante la infusión de N-acetilcisteína. CONCLUSIONES: La administración de antídotos en este SUP es infrecuente, mayoritariamente acorde a las recomendaciones y sin efectos secundarios importantes. Debe insistirse en la necesidad de limitar el uso de flumazenilo a los casos claramente indicados, y comprobando siempre la ausencia de contraindicaciones

INTRODUCTION: Poisoning is an infrequent cause of consultation in a pediatric emergency department (PED), but it can be potentially serious. Pediatricians should know how to use the available antidotes properly. OBJECTIVES: To analyze the use of antidotes in a PED and to assess the suitability of their indications. MATERIALS AND METHODS: A retrospective review of antidote use in a PED between January 2008 and June 2012. Inclusion criteria were age younger than 18 years and consultation for suspicious poisoning by a substance that could be treated with an antidote. The adequacy of antidote indication was based on the recommendations of the Spanish Society of Pediatric Emergencies (SSPE). RESULTS: A total of 1728 consultations for suspicious poisoning (0.4% of the total visits in the PED) were recorded. In 353 cases (20.4%) the involved poison could be treated with an antidote. Sixty-seven patients received an antidote (3.9% of consultations for suspicious poisoning), and a total of 69 administrations of an antidote were made: 100% oxygen (46), N-acetylcysteine (10), flumazenil (4), naloxone (3), deferoxamine (2), vitamin K (2), bicarbonate (1), and carnitine (1). In 3 cases there was no indication for administration: flumazenil without respiratory depression, and vitamin K following coumarin exposure. As side effects, agitation was noted after the use of flumazenil, and a decrease in the prothrombin time during infusion of N-acetylcysteine. CONCLUSIONS: The administration of antidotes in this PED is uncommon and, mainly, in accordance with the SSPE recommendations, and without serious side effects. The use of flumazenil needs to be limited to the cases with a clear indication and without any contraindication

[Antidote use in a pediatric emergency department]. / Uso de antídotos en un servicio de urgencias pediátricas.

INTRODUCTION: Poisoning is an infrequent cause of consultation in a pediatric emergency department (PED), but it can be potentially serious. Pediatricians should know how to use the available antidotes properly. OBJECTIVES: To analyze the use of antidotes in a PED and to assess the suitability of their indications. MATERIALS AND METHODS: A retrospective review of antidote use in a PED between January 2008 and June 2012. Inclusion criteria were age younger than 18 years and consultation for suspicious poisoning by a substance that could be treated with an antidote. The adequacy of antidote indication was based on the recommendations of the Spanish Society of Pediatric Emergencies (SSPE). RESULTS: A total of 1728 consultations for suspicious poisoning (0.4% of the total visits in the PED) were recorded. In 353 cases (20.4%) the involved poison could be treated with an antidote. Sixty-seven patients received an antidote (3.9% of consultations for suspicious poisoning), and a total of 69 administrations of an antidote were made: 100% oxygen (46), N-acetylcysteine (10), flumazenil (4), naloxone (3), deferoxamine (2), vitamin K (2), bicarbonate (1), and carnitine (1). In 3 cases there was no indication for administration: flumazenil without respiratory depression, and vitamin K following coumarin exposure. As side effects, agitation was noted after the use of flumazenil, and a decrease in the prothrombin time during infusion of N-acetylcysteine. CONCLUSIONS: The administration of antidotes in this PED is uncommon and, mainly, in accordance with the SSPE recommendations, and without serious side effects. The use of flumazenil needs to be limited to the cases with a clear indication and without any contraindication.

Evaluación de los indicadores de calidad en intoxicaciones pediátricas en un servicio de urgencias / Assessment of quality indicators in pediatric poisoning in an emergency service

INTRODUCCIÓN: La evaluación de indicadores de calidad permite comparar el proceso asistencial con un estándar, detectar deficiencias y aplicar acciones de mejora. MATERIAL Y MÉTODO: Se evaluaron los 20 indicadores de calidad en intoxicaciones pediátricas en todas las consultas por sospecha de intoxicación recibidas en el servicio de urgencias de un hospital de tercer nivel desde enero de 2011 a junio de 2012. La recogida de datos se realizó por revisión retrospectiva de las historias clínicas. RESULTADOS: Se alcanzó el estándar en 11 indicadores y no se alcanzó en 6: administración de carbón activado en las 2 primeras horas de la ingesta (estándar ≥ 90%, resultado = 83,5%); atención dentro de los 15 min desde la llegada a urgencias (estándar ≥ 90%, resultado = 60,4%); inicio de la descontaminación digestiva dentro de los 20 min desde la llegada a urgencias (estándar ≥ 90%, resultado = 29,7%); realización de electrocardiograma a los pacientes intoxicados con sustancias cardiotóxicas (estándar ≥ 95%, resultado = 87%); comunicación judicial de los casos de intoxicación que puede encubrir delito (estándar ≥ 95%, resultado = 31,3%) y registro del conjunto mínimo de datos del paciente intoxicado (estándar ≥ 90%, resultado = 1,9%). Tres indicadores no pudieron evaluarse debido al pequeño número de casos en el que eran aplicables (n < 5). CONCLUSIONES: Las principales deficiencias detectadas están en relación con el tiempo de asistencia, el registro de datos y la cumplimentación del parte judicial. La priorización de estos pacientes, el diseño de una lista de comprobación que recoja los aspectos más importantes de su manejo y la creación de campos de registro obligatorios en la historia clínica informatizada son acciones de mejora clave en este servicio de urgencias

INTRODUCTION: Assessment of quality indicators allows clinicians to evaluate clinical assistance with a standard, to detect deficiencies and to improve medical assistance. MATERIAL AND METHOD: Patients who came to emergency services of a tertiary level hospital for suspicion of poisoning from January 2011 to June 2012 were assessed using 20 quality indicators of pediatric poisoning. Data collection was performed by retrospective review of clinical reports. RESULTS: A total of 393 patients were admitted for suspicion of poisoning (0.3% of all admissions).The standard was reached in 11 indicators and not reached in 6: administration of activated charcoal within 2 hours of poison ingestion (standard = 90%, result = 83.5%); attention within the first 15 minutes of arriving in the emergency service (standard = 90%, result = 60.4%); start of gastrointestinal decontamination within 20 minutes of arrival in emergency services(standard = 90%, result = 29.7%); performing of electrocardiogram on the patients poisoned with cardiotoxic substances (standard = 95%, result = 87%); judicial communication of cases of poisoning that could conceal a crime (standard = 95%, result = 31.3%), and collection of the minimal set of information of poisoned patients (standard = 90%, result = 1.9%). Three indicators could not be evaluated as a consequence of the limited number of cases where they could be applied (<5). CONCLUSIONS: The main deficiencies are related to delay in assistance, collection of information and completion of judicial reports. Giving these patients priority, designing a checklist to collect the main points of their management, and creating obligatory fields for data in computerized medical records, are the main actions available to achieve pediatric poisoning quality indicators in this emergency service

[Assessment of quality indicators in pediatric poisoning in an emergency service]. / Evaluación de los indicadores de calidad en intoxicaciones pediátricas en un servicio de urgencias.

INTRODUCTION: Assessment of quality indicators allows clinicians to evaluate clinical assistance with a standard, to detect deficiencies and to improve medical assistance. MATERIAL AND METHOD: Patients who came to emergency services of a tertiary level hospital for suspicion of poisoning from January 2011 to June 2012 were assessed using 20 quality indicators of pediatric poisoning. Data collection was performed by retrospective review of clinical reports. RESULTS: A total of 393 patients were admitted for suspicion of poisoning (0.3% of all admissions).The standard was reached in 11 indicators and not reached in 6: administration of activated charcoal within 2hours of poison ingestion (standard=90%, result=83.5%); attention within the first 15minutes of arriving in the emergency service (standard=90%, result=60.4%); start of gastrointestinal decontamination within 20minutes of arrival in emergency services (standard=90%, result=29.7%); performing of electrocardiogram on the patients poisoned with cardiotoxic substances (standard=95%, result=87%); judicial communication of cases of poisoning that could conceal a crime (standard=95%, result=31.3%), and collection of the minimal set of information of poisoned patients (standard=90%, result=1.9%). Three indicators could not be evaluated as a consequence of the limited number of cases where they could be applied (<5). CONCLUSIONS: The main deficiencies are related to delay in assistance, collection of information and completion of judicial reports. Giving these patients priority, designing a checklist to collect the main points of their management, and creating obligatory fields for data in computerized medical records, are the main actions available to achieve pediatric poisoning quality indicators in this emergency service.

Estudio descriptivo de los hemocultivos positivos en un servicio de urgencias pediátrico / Positive blood cultures in a pediatric emergency department: a descriptive analysis

Se describe las patologías y los microorganismos que causan bacteriemia y la influencia del hemocultivo (HC) positivo en urgencias en el manejo posterior. Se trata de un estudio retrospectivo de los HC positivos realizados en urgencias durante 2008 y 2009. Se consideró el cambio de la actitud terapéutica, el inicio o modificación del antibiótico y/o el ingreso hospitalario. Se realizaron 7.582 HC. En 382 (5,0%) hubo crecimiento bacteriano, 88 (23,0%) fueron verdaderos positivos. La neumonía y la infección urinaria fueron las principales patologías asociadas a bacteriemia y S. pneumoniae y E. coli los microorganismos más frecuentes. El HC positivo condicionó cambio de actitud terapéutica en un tercio de los episodios, principalmente en pacientes con fiebre sin foco. Se concluye que la positividad del HC condicionó un cambio de actitud terapéutica en un número significativo de pacientes, aunque dada la baja prevalencia de bacteriemia el impacto global fue bajo (AU)

We describe the infections and microorganisms causing bacteremia in an emergency department and to analyze the influence of a positive blood culture on subsequent management. It is a retrospective study of positive blood cultures ordered in the emergency department in 2008 and 2009. A change in therapeutic approach was defined as the initiation or modification of antibiotic therapy and/or hospital admission. A total of 7582 blood cultures were ordered. Bacteria grew in 382 (5.0%); 88 (23.0%) were true positives. Pneumonia and urinary tract infection were the main diagnoses associated with bacteremia. The pathogens implicated most often were Streptococcus pneumoniae and Escherichia coli. A positive blood culture led to a change in therapeutic approach in a third of the cases, mainly in patients with fever of unknown origin. We conclude that the management changed on the basis of blood culture findings in a significant number of cases although given the low prevalence of bacteremia, the overall impact was low (AU)

Ingesta de cáusticos: situación actual y puesta al día de las recomendaciones / Caustic ingestion: local situation and review of updated recommendations

Introducción: La ingesta de productos domésticos es la segunda causa de consulta por sospecha de intoxicación en la edad pediátrica, y entre éstos destacan los productos cáusticos por su potencial toxicidad y riesgo de secuelas. Objetivo: Describir las características epidemiológicas y clínicas de los pacientes que ingresan desde urgencias por sospecha de ingesta de cáusticos. Analizar los factores de riesgo de lesiones esófago gástricas. Revisar las recomendaciones actuales de manejo .Material y métodos: Estudio retrospectivo de los pacientes ingresados desde urgencias por sospecha de ingesta de cáusticos entre enero de 2005 y abril de 2010. Resultados: Se obtuvo una muestra de 78 pacientes, 45 de ellos varones (57,7%), mediana de edad de 2,2 años (rango: 1-17,3 años). En 13 casos el producto se encontraba fuera de su envase original y en 36 niños la familia había inducido el vómito o administrado algún líquido como diluyente. Presentaron síntomas 52 niños y la exploración física fue anormal en 46 pacientes. Se realizaron 39 endoscopias digestivas, objetivando lesiones en 7 pacientes. Al comparar los pacientes con endoscopia normal y alterada, se identifican como factores de riesgo de lesiones digestivas la realización de algún vómito (p=0,01) y la presencia de al menos 2 síntomas (p=0,03). Ningún paciente sin endoscopia presentó complicaciones posteriores. Conclusiones: Es necesario mejorar la educación sanitaria informando a las familias sobre medidas preventivas y de manejo inmediato, evitando maniobras que pueden agravar la situación. Algunos pacientes podrían beneficiarse de una observación clínica sin medidas de tratamiento más agresivas (AU)

Background: Household product ingestion is the second cause of visiting an Emergency Department for poisoning in children. Among these products, caustics are of great interest because of their potential toxicity and risk of sequelae. Objectives: To describe the epidemiological and clinical features of patients admitted to our hospital due to possible caustic ingestion. To analyse the risk factors associated with oesophageal or gastric injury. To review the latest treatment recommendations. Materials and methods: Retrospective review of all patients admitted with suspicion of caustic ingestion between January 2005 and April 2010. Epidemiological, clinical and therapeutic aspects were recorded. Results: A total of 78 patients were admitted, 45 (57.7%) were male, with a median age of 2.2 years (range: 1-17.3 years). In 13 cases the product was kept in a container different than the original. In 36 children, the family had induced vomiting or had given a liquid to dilute the product. Fifty two patients were symptomatic, and 46 of them had some sign on physical examination. Thirty nine oesophagoscopies were performed, and 7 oesophageal or gastric lesions were observed. When patients with normal and abnormal endoscopic findings were compared, the factors associated with an increased risk of mucosal injury were vomiting (P=0.01), and two or more symptoms at admission (P=0.03). No complication was described in patients without endoscopy. Conclusions: Family education about preventive and initial measures after caustic ingestion must be improved in an attempt to prevent wrong actions which can be harmful. Some patients might benefit from clinical observation without aggressive therapeutic measures (AU)

[Caustic ingestion: current situation and review of updated recommendations]. / Ingesta de cáusticos: situación actual y puesta al día de las recomendaciones.

BACKGROUND: Household product ingestion is the second cause of visiting an Emergency Department for poisoning in children. Among these products, caustics are of great interest because of their potential toxicity and risk of sequelae. OBJECTIVES: To describe the epidemiological and clinical features of patients admitted to our hospital due to possible caustic ingestion. To analyse the risk factors associated with oesophageal or gastric injury. To review the latest treatment recommendations. MATERIALS AND METHODS: Retrospective review of all patients admitted with suspicion of caustic ingestion between January 2005 and April 2010. Epidemiological, clinical and therapeutic aspects were recorded. RESULTS: A total of 78 patients were admitted, 45 (57.7%) were male, with a median age of 2.2 years (range: 1-17.3 years). In 13 cases the product was kept in a container different than the original. In 36 children, the family had induced vomiting or had given a liquid to dilute the product. Fifty two patients were symptomatic, and 46 of them had some sign on physical examination. Thirty nine oesophagoscopies were performed, and 7 oesophageal or gastric lesions were observed. When patients with normal and abnormal endoscopic findings were compared, the factors associated with an increased risk of mucosal injury were vomiting (P=0.01), and two or more symptoms at admission (P=0.03). No complication was described in patients without endoscopy. CONCLUSIONS: Family education about preventive and initial measures after caustic ingestion must be improved in an attempt to prevent wrong actions which can be harmful. Some patients might benefit from clinical observation without aggressive therapeutic measures.

Novel influenza A (H1N1) encephalitis in a 3-month-old infant.

Seasonal influenza virus infection has been associated with a variety of neurologic complications. We report a case of novel influenza A (H1N1) encephalitis in an infant aged 3 months with an upper respiratory infection, who presented seizures. The infection was confirmed in nasopharyngeal aspirate and cerebrospinal fluid. Treatment with oseltamivir was started. He was discharged without any neurologic sequelae.