Urgencia Pediátrica del Hospital Universitario 12 de Octubre / Pediatric Emergency of the University Hospital 12 de Octubre

El objetivo final de la Unidad es prestar una asistencia sanitaria eficiente dentro de un marco de humanización como parte fundamental de la calidad del servicio prestado. La Urgencia Pediátrica atiende a pacientes menores de 16 años que precisen cualquier tipo de atención y por parte de cualquier especialidad. Se ven alrededor de 54.000 urgencias anuales. Hay un sistema de clasificación que realiza la enfermería. Posteriormente le atienden los pediatras en las consultas. Desde estas, la mayor parte de los niños se pueden dar de alta (88%), otros pasan al área de terapia inhalada (4%) y el resto a la zona de Observación (8%). Se ingresan cada año unos 2.300 pacientes. Periódicamente se valoran los indicadores de calidad marcados por la SEUP. Desde el punto de vista docente, se forma anualmente 10 residentes de Pediatría, 4 de Alergia y 20 de Medicina Familiar y Comunitaria (AU)

The final objective of the Unit is to provide efficient health care within a framework of humanization as a fundamental part of the quality of the service provided. Pediatric Emergency attends to patients under 16 years of age who require any type of attention and by any specialty. Approximately 54,000 emergencies are seen per year. There is a Classification system performed by the nursing service. After, the pediatricians see the patient in their consultation. From these, most of the children can be discharged (88%), others are transferred to area of inhaled therapies area (4%) and the rest go to the Observation area (8%). Every year, about 2,300 patients are hospitalized. Periodically, the quality indicated marked by the SEUP (Spanish Society of Pediatric Emergencies) are evaluated. From the teaching point of view, 10 residence of Pediatrics are trained, 4 in Allergy and 20 in Family and Community Medicine (AU)

Identification of airborne radioactive spatial patterns in Europe - Feasibility study using Beryllium-7.

The present study proposes a methodology to identify spatial patterns in airborne radioactive particles in Europe. The methodology is based on transforming the activity concentrations in the set of stations for each month (monthly index), due to the tightly spaced sampling intervals (daily to monthly), in combination with hierarchical and non-hierarchical clustering approaches, due to the lack of a priori knowledge of the number of clusters to be created. Three different hierarchical cluster methodologies are explored to set the optimal number of clusters necessary to initialize the non-hierarchical one (k-means). To evaluate this methodology, cosmogenic beryllium-7 ((7)Be) data, collected between 2007 and 2010 at 19 sampling stations in European Union (EU) countries and stored in the Radioactivity Environmental Monitoring (REM) database, are used. This methodology yields a solution with three distinguishable clusters (south, central and north), each with a different evolution of the (7)Be monthly index. Clear differences between monthly indices are shown in both intensity and time trends, following a latitudinal distribution of the sampling stations. This cluster result is evaluated performing ANOVA analysis, considering the original (7)Be activity concentrations grouped in each cluster. The statistical results (among clusters and sampling stations within clusters) confirm the spatial distribution of (7)Be in Europe, and, hence, reinforce the use of this methodology. Finally, the impact of tropopause height on this grouping is successfully tested, suggesting its influence on the spatial distribution of (7)Be in Europe. For airborne radioactive particles the analysis gave valuable results that improve knowledge of these atmospheric compounds in Europe. Hence, this work addresses a methodology to a grouping of airborne sampling stations, 1) allowing a better understanding of the distribution of (7)Be activity concentrations in the EU, and 2) serving as a basis for further investigation of the heterogeneity of airborne radioactivity concentrations in Europe.

La expresión clínica y epidemiológica actual por tos ferina en un hospital terciario / The clinical expression and current epidemiology of whooping cough in a tertiary hospital

Objetivo: Describir el patrón clínico y epidemiológico de la expresión de tos ferina. Material y métodos: Estudio retrospectivo observacional de pacientes entre 0 y 15 años de edad diagnosticados de infección por Bordetella pertussis entre enero de 2009 y diciembre de 2011 en un hospital terciario de Madrid. Resultados: Se confirmaron microbiológicamente 65 casos, un 46,1% de ellos en menores de 1 año; un 20% de los niños no había recibido ninguna vacuna de B. pertussis, un 77% de ellos debido a que eran menores de 2 meses. El síntoma principal fue la tos paroxística (61,5%), con una media de 11 días de evolución. La radiografía de tórax y el hemograma no ayudaron a esclarecer el diagnóstico. Conclusión: La tos ferina es una enfermedad que cabe considerar en lactantes y adolescentes. Es necesario adoptar determinadas medidas preventivas para disminuir la incidencia de esta patología (AU)

Title: The clinical expression and current epidemiology of whooping cough in a tertiary hospital Objective: To describe the clinical and epidemiological pattern of expression of pertussis. Methods: Retrospective observational study of patients between 0 and 15 years of age diagnosed with infection by Bordetella pertussis between January 2009 and December 2011 in a tertiary hospital in Madrid. Results: 65 cases were confirmed microbiologically, 46.1% of them in children under 1 year; 20% of children had received no vaccine for B. pertussis, 77% of them were under 2 months old. The main symptom was ther paroxistical cough (61.5%), with 11 days of average evolution. Chest X ray and blood test didn’t help to find out the diagnosis. Conclusion: Pertussis is a disease to be considered in infants and adolescents. It is necessary to perform certain preventive attitudes to reduce the incidence of this disease (AU)

Manejo del traumatismo alvéolo-dentario infantil en el Servicio de Urgencias de un hospital terciario / Management of pediatric dental injury in the Emergency Department of a tertiary hospital

Introducción: el traumatismo alvéolo-dentario es muy frecuente en la infancia y supone un motivo habitual de consulta en los Servicios de Urgencias pediátricos. Objetivo: estudiar el manejo de los traumatismos dentales en un hospital terciario. Material y métodos: estudio descriptivo retrospectivo. Se incluyeron todos los menores de 15 años que consultaron por traumatismo dental en la Urgencia Pediátrica del Hospital 12 de Octubre (Madrid, España) entre septiembre de 2008 y agosto de 2010. Durante este periodo se puso en marcha un protocolo de manejo de estos pacientes en nuestro centro. Resultados: en el periodo de estudio fueron atendidos 374 pacientes, el 63% varones, con una media de edad de 4,45 años. En el 84% de los casos, la etiología fue casual, seguido de un 3% relacionado con accidentes deportivos. El 32% de los pacientes fue derivado desde otros centros para valoración por Cirugía Maxilofacial. El 60% fue atendido exclusivamente por pediatras. Las causas más frecuentes de atención por parte de Cirugía Maxilofacial fueron: sutura de laceración gingival (6,4%), extracción dental (3%) y ferulización (1,3%). El 83,4% requirió solamente tratamiento médico. Conclusiones: el trauma dental es una causa frecuente de consulta en los Servicios de Urgencias y de derivación a hospitales de referencia. La mayoría de los pacientes presenta lesiones menores que no precisan la realización de pruebas complementarias ni requieren tratamiento quirúrgico, y pueden ser manejadas por un pediatra siguiendo protocolos consensuados con especialistas en Cirugía Maxilofacial (AU)

Introduction: dental injury is very common in childhood and a frequent reason for consultation in pediatric emergency departments. Objectives: to study the management of dental injury in a tertiary hospital. Material and methods: retrospective descriptive study. All patients under 15 years old consulting for dental injury in the Pediatric Emergency Department of Hospital 12 de Octubre between September 2008 and August 2010 were included. During this period of time a specific management protocol of these patients was started. Results: a total of 374 patients were treated, 63% being males, with a median age of 4.45 years. In 84% of cases the etiology was casual, followed by a 3% sports-related accident. Thirty-two percent of the patients were referred from other centers for Maxillofacial Surgery evaluation. In 60% of cases, children were treated exclusively by pediatricians. The most common reasons for maxillofacial surgery evaluation were: suture of gingival laceration (6.4%), dental extraction (3%) and ferulization (1.3%); 83.4% required only medical treatment. Conclusions: dental injury is a common reason for consultation in the pediatric emergency department and referral to other centers. Most patients have mild lesions so they need neither complementary studies nor surgery treatment and should be managed by pediatricians following agreed protocols (AU)

Presencia de los familiares durante la realización de procedimientos invasivos / Presence of family members while performing invasive procedures. A prospective study

Introducción: En nuestro medio tradicionalmente no se ha permitido a los familiares de los pacientes permanecer junto al niño cuando se realizaban procedimientos invasivos. Objetivo: Evaluar el grado de satisfacción de los familiares, el personal sanitario y del propio paciente con la presencia de los familiares durante la realización de los procedimientos dolorosos en un servicio de urgencias pediátricas. Material y métodos: Se realizó un estudio observacional prospectivo. Se diseñó un protocolo de actuación y se instruyó al personal sanitario. Se diseñó una encuesta con datos demográficos, datos del procedimiento y grado de satisfacción tanto del paciente y su familiar como del profesional sanitario. Resultados: Se obtuvieron datos de 75 procedimientos. En 5 de ellos los familiares rechazaron la opción de estar presentes. Los más frecuentes fueron punciones lumbares (44%), sutura/cura de heridas (22,7%) y venopunciones (17,3%). El 100% de los niños quisieron que sus familiares estuvieran presentes. El 90% de los familiares y el 57% de los profesionales opinaron que la presencia de los familiares había facilitado el procedimiento. El 90% de los familiares y el 76% de los profesionales opinaron que había sido beneficioso para el niño. El 95% de los familiares y el 71% de los profesionales opinaron que se debería dar la opción a los familiares de estar presentes. El 73% de los profesionales quedaron satisfechos. En una escala del 1 al 10 la satisfacción global de los familiares fue de un 9,5. Conclusiones: En nuestra experiencia la presencia familiar es una práctica posible que facilita la realización de los procedimientos dolorosos y resulta beneficiosa para el niño. Encontramos una alta satisfacción familiar y al mismo tiempo una amplia aceptación por parte del personal sanitario(AU)

Introduction: Family members of child patients have traditionally not been allowed to be present during invasive procedures. Objectives: To evaluate the level of satisfaction of family members, healthcare professionals, and the patients themselves, when family members are present during invasive procedures carried out in the pediatric emergency department. Materials and methods: A prospective observational study was carried out, which included a questionnaire containing demographic information, the details of the procedure, and the level of satisfaction of the patient, their family members, and the healthcare professionals present. Results: Data was obtained from 75 procedures. In 5 of these, family members chose not to be present during the procedure. The most frequent procedures were lumbar punctures (44%), laceration repairs (22,7%) and venopunctures (17,3%). All (100%) the children who were asked wanted their family members to be present. 90% of family members and 57% of healthcare professionals were of the opinion that the presence of family members facilitated the procedure. Furthermore, 90% of family members and 76% of healthcare professionals thought that family presence was beneficial to the patient. 95% of family members and 71% of healthcare professionals thought that the option to be present during invasive procedures should be given to family members. 73% of healthcare professionals were satisfied with the presence of family members. On a scale of one to ten, overall satisfaction of family members was 9.5.Conclusions: In our experience, family presence during invasive procedures is possible, and we have found this to be beneficial to the child. We also found that both family members and healthcare professionals were accepting and also satisfied with this new practice policy(AU)

[Presence of family members while performing invasive procedures. A prospective study]. / Presencia de los familiares durante la realización de procedimientos invasivos.

INTRODUCTION: Family members of child patients have traditionally not been allowed to be present during invasive procedures. OBJECTIVES: To evaluate the level of satisfaction of family members, healthcare professionals, and the patients themselves, when family members are present during invasive procedures carried out in the pediatric emergency department. MATERIALS AND METHODS: A prospective observational study was carried out, which included a questionnaire containing demographic information, the details of the procedure, and the level of satisfaction of the patient, their family members, and the healthcare professionals present. RESULTS: Data was obtained from 75 procedures. In 5 of these, family members chose not to be present during the procedure. The most frequent procedures were lumbar punctures (44%), laceration repairs (22,7%) and venopunctures (17,3%). All (100%) the children who were asked wanted their family members to be present. 90% of family members and 57% of healthcare professionals were of the opinion that the presence of family members facilitated the procedure. Furthermore, 90% of family members and 76% of healthcare professionals thought that family presence was beneficial to the patient. 95% of family members and 71% of healthcare professionals thought that the option to be present during invasive procedures should be given to family members. 73% of healthcare professionals were satisfied with the presence of family members. On a scale of one to ten, overall satisfaction of family members was 9.5. CONCLUSIONS: In our experience, family presence during invasive procedures is possible, and we have found this to be beneficial to the child. We also found that both family members and healthcare professionals were accepting and also satisfied with this new practice policy.

[99mTc-MAA peritoneal scintigraphy in pleuroperitoneal comunication in peritoneal dialysis patients]. / Gammagrafía peritoneal con 99mTc-MAA en las comunicaciones pleuroperitoneales en pacientes en diálisis peritoneal.

Peritoneal dialysis is a fully-contrasted alternative for the treatment of end-stage renal disease although it is not exempt of complications. Peritonitis and exit-site infections are among the most frequent complications found. Pleural effusion secondary to pleuroperitoneal communication (PPC) is a serious and uncommon complication in these patients. We present the case of a 50-year old man diagnosed of end-stage renal disease undergoing treatment with peritoneal dialysis who presented progressive dyspnea and right pleural effusion. The peritoneal scintigraphy with (99m)Tc-MAA makes it possible to confirm communication of intraperitoneal dialysis fluid to the pleural cavity.

Panton-Valentine leukocidin-positive Staphylococcus aureus skin and soft tissue infections among children in an emergency department in Madrid, Spain.

Fifty-three children who attended the emergency department with community-associated (CA) Staphylococcus aureus skin and soft tissue infections (SSTIs) were enrolled in the study. Seven cases of infection (13.2%) were due to methicillin-resistant S. aureus (MRSA). Twelve of 46 available isolates (26.1%) were Panton-Valentine leukocidin (PVL)-positive. PVL-positive S. aureus SSTIs were more frequently associated with abscesses and cellulitis (75% vs. 38%, p 0.028), and more commonly required incision and drainage (75% vs. 21%, p 0.001). Most PVL-positive CA-MRSA isolates belonged to a single multilocus sequence type (ST8). In contrast, PVL-positive methicillin-susceptible S. aureus isolates belonged to four different sequence types (ST8, ST30, ST80, ST120).

[Utility of myocardial perfusion SPECT for evaluation of patients from Chest Pain Unit]. / Análisis y utilidad de la tomografía de emisión de fotón único de perfusión miocárdica en la evaluación de pacientes de la Unidad de dolor torácico.

UNLABELLED: The Chest Pain Units (CPU) are currently the best solution to improve management of patients with acute chest pain in the Emergency Room thanks to the use of reliable ischemia diagnostic detection tests and early treatment. OBJECTIVE: To assess the value of myocardial perfusion SPECT (MPS) in the CPU in order to treat acute coronary syndromes (ACS) early and discharge patients with low risk of coronary artery disease (CAD) who can be treated as outpatients. MATERIAL AND METHODS: We studied 629 patients from January 2003 to September 2005 with acute chest pain suggestive of angina, normal cardiac enzymes and normal or non-diagnostic ECG who had been referred to Nuclear Medicine for evaluation with a stress test for ischemia: 32 p treadmill stress testing and 597 p MPS (525 p exercise-rest and 72 p pharmacologic stress test). We compared the results with catheterization and clinical follow up for a 6-months period, evaluating new coronary events. RESULTS: 76 % of MPS were normal and 24 % pathological. Only 1.5 % of the patients with normal MPS had CAD or coronary events in the follow-up, increasing to 35.2 % in patients with ischemia. A total of 45 catheterizations were performed, showing CAD 27 (24 with pathological MPS). A total of 2.6 % of the patients had coronary events during follow-up, 75 % of whom had pathological MPS. CONCLUSION: The MPS improves diagnosis of ACS in the CPU, with a very low number of new coronary events at 6 months of the follow-up and permits safe discharge of these patients.

[Iatrogenic lung microembolism detected by 18FDG PET/CT]. / Microembolia pulmonar iatrogénica detectada mediante 18F-FDG PET/TC.

We present the cases of two oncology patients: a male with Hodgkin's disease after completion of chemotherapy, and a woman recently diagnosed of melanoma, who underwent positron emission tomography/computed tomography (PET/CT) with 18F-FDG for therapeutic monitoring and initial staging, respectively. In both cases, hypermetabolic foci of 18F-FDG in lung parenchyma were found, without morphologic abnormalities in CT. These findings would have been consistent with lung pathology in the absence of any anatomic correlation. Combined PET/CT interpretation was of lung microembolisms probably originated at the injection site.

Microembolia pulmonar iatrogénica detectada mediante 18F-FDG PET/TC / Iatrogenic lung microembolism detected by 18FDG PET/CT

Presentamos los casos de dos pacientes oncológicos: varón con enfermedad de Hodgkin tras finalizar tratamiento quimioterápico y mujer recién diagnosticada de melanoma coroideo, a los que se realiza tomografía por emisión de positrones/tomografía computarizada (PET/TC) con 18F-fluorodesoxiglucosa ( 18F-FDG) para monitorización terapéutica y estudio de extensión inicial, respectivamente. En ambos casos se encuentran focos hipermetabólicos de 18F-FDG en parénquima pulmonar, sin concordancia morfológica en la TC. Estos hallazgos hubieran sugerido patología pulmonar en caso de no disponer de estudio anatómico conjunto. La interpretación de la PET/TC fue de microembolismos pulmonares probablemente originados en el punto de inyección

We present the cases of two oncology patients: a male with Hodgkin's disease after completion of chemotherapy, and a woman recently diagnosed of melanoma, who underwent positron emission tomography/computed tomography (PET/CT) with 18F-FDG for therapeutic monitoring and initial staging, respectively. In both cases, hypermetabolic foci of 18F-FDG in lung parenchyma were found, without morphologic abnormalities in CT. These findings would have been consistent with lung pathology in the absence of any anatomic correlation. Combined PET/CT interpretation was of lung microembolisms probably originated at the injection site

La experiencia del "Modelo Alzira" del Hospital de La Ribera a La Ribera-área 10 de salud: la consolidación del modelo / The experience of the “Alzira Model”: from the hospital of Ribera to la Ribera-Health Area 10: consolidation of the model

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[Follow-up of children and young adults with differentiated thyroid cancer treated with radioiodine]. / Seguimiento de niños y jóvenes adultos con cáncer diferenciado de tiroides (CDT) tratados con radioyodo.

This is a retrospective study carried out in a group of 30 patients with differentiated thyroid cancer (age at diagnosis equal to or less than twenty years old). The aim of the study is to evaluate outcome after 131I therapy. Patients were classified into three groups on the basis of initial surgery, pathology and scintigraphic results: group I (thyroid extent), group II (locoregional extent), and group III (distant metastatic disease). Clinical parameters, 131I scans, serum thyroglobulin determinations and 131I therapeutic administered doses were evaluated in the follow-up. Some other complementary techniques such as chest X-ray and pulmonary function tests are also described. Scintigraphic absence of thyroid tissue has been observed in 83% of the cases; high thyroglobulin level is still detectable in 34% of the patients as a single evidence of disease, and 21% remain without any abnormal clinical, scintigraphic or analytical findings. Total doses administered have increased in groups I, II and III respectively, and have also been inversely proportional to the extension of lymph node surgery. At present, all the patients are alive and in good general condition. According to the results obtained, we conclude that children and young adults with DTC should undergo periodical 131I therapeutic doses in case of positive scans (once total thyroidectomy has been realized, with or without lymph node resection depending on the extension of disease). In our experience, the use of radioiodine is effective and safe in the follow-up of children and youngs with DTC.

Seguimiento de niños y jóvenes adultos con cáncer diferenciadode tiroides (CDT) tratados con radioyodo / Follow-up of children and young adults with differentiated thyroid cancer treated with radioiodine

Este es un estudio retrospectivo realizado en un grupo de treinta pacientes con carcinoma diferenciado de tiroides (edad al dignóstico igual o menor a veinte años), que tiene como objetivo valorar la respuesta al tratamiento con radioyodo. Los pacientes fueron clasificados en tres grupos según los resultados quirúrgicos, anatomopatológicos y gammagráficos iniciales: grupo I (enfermedad limitada al tiroides), grupo II (enfermedad locorregional), grupo III (afectación metastásica a distancia). En el seguimiento se evaluaron parámetros clínicos, resultados de rastreos gammagráficos con Iodo-131, determinaciones de tiroglobulina sérica y dosis terapeúticas de radioyodo administradas. También se describen otras técnicas complementarias como la radiología de tórax y las pruebas de función respiratoria. Hemos observado una negativización gammagráfica en el 83 por ciento de los casos; un 34 por ciento presenta niveles de tiroglobulina elevados como único hallazgo sugestivo de existencia de enfermedad y un 21 por ciento no presenta hallazgos clínicos, analíticos o gammagráficos patológicos. Las dosis totales de radioyodo administradas han sido crecientes en los grupos I, II y III respectivamente, e inversamente proporcionales a la extensión de la limpieza ganglionar efectuada. En la actualidad todos los pacientes están vivos y presentan un buen estado general.De acuerdo con los resultados obtenidos, concluímos que el manejo adecuado del CDT en este grupo de edad debe incluir rastreos gammagráficos periódicos con 131I y dosis terapeúticas de 131I en caso de rastreos positivos (una vez realizada la tiroidectomía total, con o sin limpieza ganglionar dependiendo de la extensión de la enfermedad). Según nuestra experiencia, el empleo de radioiodo es eficaz y seguro en el seguimiento de niños y jóvenes con CDT. (AU)

[Changes in feeding behavior of patients who had received enteral nutrition during the 1st year of life]. / Alteraciones de la conducta alimentaria en pacientes que precisaron nutrición enteral durante el primer año de vida.

UNLABELLED: Enteral feedings delivered by either gastrostomy or a nasogastric tube are often used in infants and toddlers to ensure adequate caloric and nutrient intake. If we are not aware of a rapid introduction of oral feedings they may develop poor feeding skills. PATIENTS: Seven infants (mean age: 6.7 months; SD: 3.6) presented this problem during the 1993-96 period. Six of them were using a nasogastric tube, another one a gastrostomy (PEG). At the beginning of the enteral feeding regimen their weight was -3.32 z-score (SD: -1.2) and for height: -2.11 z-score (SD: -0.51). The underlying disease was gastroesophageal reflux (n = 4), esophageal atresia (n = 1), short bowel syndrome (n = 1) and unexplained anorexia (n = 1). RESULTS: The mean length of artificial nutrition was 20 months (SD: 11.5), although two of the patients still receive nocturnal enteral drip. Six patients resumed a normal feeding pattern within 3 months to 2 years after behavior modification program was started. CONCLUSION: According to our experience, there is a critical period involved with oral feeding during the first year of life. If not aware, children in transition for tube to oral feeding may display oral-motor, sensory and developmental feeding problems.