Design, Implementation, and Configuration of Laser Systems for Vehicle Detection and Classification in Real Time.

The use of real-time vehicle detection and classification systems is essential for the accurate management of traffic and road infrastructure. Over time, diverse systems have been proposed for it, such as the widely known magnetic loops or microwave radars. However, these types of sensors do not offer all the information currently required for exhaustive and comprehensive traffic control. Thus, this paper presents the design, implementation, and configuration of laser systems to obtain 3D profiles of vehicles, which collect more precise information about the state of the roads. Nevertheless, to obtain reliable information on vehicle traffic by means of these systems, it is fundamental to correctly carry out a series of preliminary steps: choose the most suitable type of laser, select its configuration properly, determine the optimal location, and process the information provided accurately. Therefore, this paper details a series of criteria to help make these crucial and difficult decisions. Furthermore, following these guidelines, a complete laser system implemented for vehicle detection and classification is presented as result, which is characterized by its versatility and the ability to control up to four lanes in real time.

Vehicle modeling for the analysis of the response of detectors based on inductive loops.

Magnetic loops are one of the most popular and used traffic sensors because of their widely extended technology and simple mode of operation. Nevertheless, very simple models have been traditionally used to simulate the effect of the passage of vehicles on these loops. In general, vehicles have been considered simple rectangular metal plates located parallel to the ground plane at a certain height close to the vehicle chassis. However, with such a simple model, it is not possible to carry out a rigorous study to assess the performance of different models of vehicles with the aim of obtaining basic parameters such as the vehicle type, its speed or its direction in traffic. For this reason and because computer simulation and analysis have emerged as a priority in intelligent transportation systems (ITS), this paper aims to present a more complex vehicle model capable of characterizing vehicles as multiple metal plates of different sizes and heights, which will provide better results in virtual simulation environments. This type of modeling will be useful when reproducing the actual behavior of systems installed on roads based on inductive loops and will also facilitate vehicle classification and the extraction of basic traffic parameters.

Advantages offered by the double magnetic loops versus the conventional single ones.

Due to their simplicity and operating mode, magnetic loops are one of the most used traffic sensors in Intelligent Transportation Systems (ITS). However, at this moment, their potential is not being fully exploited, as neither the speed nor the length of the vehicles can be surely ascertained with the use of a single magnetic loop. In this way, nowadays the vast majority of them are only being used to measure traffic flow and count vehicles on urban and interurban roads. This is the reason why we presented in a previous paper the double magnetic loop, capable of improving the features and functionalities of the conventional single loop without increasing the cost or introducing additional complexity. In that paper, it was introduced their design and peculiarities, how to calculate their magnetic field and three different methods to calculate their inductance. Therefore, with the purpose of improving the existing infrastructure and providing it with greater potential and reliability, this paper will focus on justifying and demonstrating the advantages offered by these double loops versus the conventional ones. This will involve analyzing the magnetic profiles generated by the passage of vehicles over double loops and comparing them with those already known. Moreover, it will be shown how the vehicle speed, the traffic direction and many other data can be obtained more easily and with less margin of error by using these new inductance signatures.

Quality of life in home-ventilated children and their families.

HMV (home mechanical ventilation) in children has increased over the last years. The aim of the study was to assess perceived quality of life (QOL) of these children and their families as well as the problems they face in their daily life.We performed a multicentric cross-sectional study using a semi-structured interview about the impact of HMV on families and an evaluation questionnaire about perceived QOL by the patient and their families (pediatric quality of life questionnaire (PedsQL4.0)). We studied 41 subjects (mean age 8.2 years). Global scores in PedsQL questionnaire for subjects (median 61.4), and their parents (median 52.2) were below those of healthy children. 24.4% received medical follow-up at home and 71.8% attended school. Mothers were the main caregivers (75.6%), 48.8% of which were fully dedicated to the care of their child. 71.1% consider economic and healthcare resources insufficient. All families were satisfied with the care they provide to their children, even though it was considered emotionally overwhelming (65.9%). Marital conflict and neglect of siblings appeared in 42.1 and 36% of families, respectively. CONCLUSIONS: Perceived QOL by children with HMV and their families is lower than that of healthy children. Parents are happy to care for their children at home, even though it negatively affects family life. What is Known: • The use of home mechanical ventilation (HMV) in children has increased over the last years. • Normal family functioning is usually disrupted by HMV. What is New: • The aim of HMV is to provide a lifestyle similar to that of healthy children, but perceived quality of life by these patients and their parents is low. • Most of the families caring for children on HMV agree that support and resources provided by national health institutions is insufficient.

Antibiotic resistance and population structure of cystic fibrosis Pseudomonas aeruginosa isolates from a Spanish multi-centre study.

The first Spanish multi-centre study on the microbiology of cystic fibrosis (CF) was conducted from 2013 to 2014. The study involved 24 CF units from 17 hospitals, and recruited 341 patients. The aim of this study was to characterise Pseudomonas aeruginosa isolates, 79 of which were recovered from 75 (22%) patients. The study determined the population structure, antibiotic susceptibility profile and genetic background of the strains. Fifty-five percent of the isolates were multi-drug-resistant, and 16% were extensively-drug-resistant. Defective mutS and mutL genes were observed in mutator isolates (15.2%). Considerable genetic diversity was observed by pulsed-field gel electrophoresis (70 patterns) and multi-locus sequence typing (72 sequence types). International epidemic clones were not detected. Fifty-one new and 14 previously described array tube (AT) genotypes were detected by AT technology. This study found a genetically unrelated and highly diverse CF P. aeruginosa population in Spain, not represented by the epidemic clones widely distributed across Europe, with multiple combinations of virulence factors and high antimicrobial resistance rates (except for colistin).

Antibiotic prescription patterns in Spanish cystic fibrosis patients: results from a national multicenter study / Patrones de prescripción de antimicrobianos en pacientes españoles con fibrosis quística: resultados de un estudio multicéntrico nacional

Objective: Information about antibiotic prescription patterns for cystic fibrosis (CF) patients and, specifically, about inhaled treatment strategies for their management is lacking in Spain due to the absence of a national patient registry. In this study we present data about antibiotic prescription in the Spanish CF context that were obtained in a multicenter study, being inhaled treatment strategies the special focus of this work. Methods: Twenty-four specialized CF units (12 adult, 12 pediatric) from 17 tertiary-care hospitals covering all Spanish Autonomous Communities provided sputa and clinical data from 15 consecutive patients. Data about antibiotic and non-antibiotic therapies prescribed to these patients during the year prior inclusion (2013) were retrospectively collected. Results: The multicenter study included 341 CF patients from all age groups and clinical status. The prevalence of oral, inhaled and intravenous therapies was 89% (n = 302), 80% (n = 273) and 31% (n = 105), respectively. The most prevalent oral agents were ciprofloxacin (n = 177, 59%), cotrimoxazole (n = 109, 36%) and amoxicillin-clavulanate (n = 99, 33%), whereas ceftazidime (n = 53, 50%), to bramycin (n = 43, 41%) and meropenem (n = 41, 49%) were the most prevalent intravenous ones. Two or more different inhaled antibiotics were administered to 67 patients (24%), 51 of them receiving 2 drugs continuously in alternating schemes. Nebulization of intravenous specific antibiotics was common (n = 39) and, in some cases, was used for maintenance purposes. Conclusions: These results show that the treatment of CF patients is evolving more rapidly than clinical consensus guidelines. Clinical trials evaluating new specific inhaled combinations and new alternative treatment regimens of the existing ones are needed (AU)

Objetivos: Existen actualmente pocos datos acerca de las pautas de tratamiento antimicrobiano administradas a los pacientes con fibrosis quística (FQ) en España, sobre todo en lo que se refiere a la antibioterapia inhalada. Esta escasez de conocimiento se debe principalmente a la ausencia de un registro nacional de datos de pacientes. En 2013 se llevó a cabo el primer estudio multicéntrico español focalizado en la microbiología de la FQ. En este trabajo presentamos los patrones de prescripción de antimicrobianos administrados durante un año a los pacientes incluidos en dicho estudio. Métodos: Se contó con la participación de 24 unidades de FQ (12 de adultos y 12 de pediatría) procedentes de 17 hospitales españoles. Cada unidad reclutó a 15 pacientes de manera consecutiva, que aportaron muestras respiratorias y datos clínicos. Se recogieron de manera retrospectiva los tratamientos antibióticos y no antibióticos administrados a estos pacientes durante el año previo a su inclusión en el estudio. Resultados: Se incluyeron 341 pacientes con FQ de todos los rangos de edad y de gravedad clínica. La prevalencia de antibioterapia oral, inhalada e intravenosa fue del 89% (n = 302), 80% (n = 273) y 31% (n = 105), respectivamente. Los fármacos administrados con mayor frecuencia por vía oral fueron ciprofloxacino (n = 177, 59%), cotrimoxazol (n = 109, 36%) y amoxicilina-cla- vulánico (n = 99, 33%), siendo ceftazidima (n = 53, 50%), tobramicina (n = 43, 41%) y meropenem (n = 41, 49%) los más frecuentes por vía intravenosa. Se administraron dos o más antibióticos por vía inhalada a 67 pacientes (24%), habiendo recibido 51 de ellos 2 antibióticos simultáneamente de manera rotatoria. La nebulización de antibióticos con formulación intravenosa fue una práctica común (n = 39) y, en algunos casos, se utilizó durante un tiempo prolongado como terapia de mantenimiento. Conclusiones: Los esquemas de tratamiento observados en este estudio demuestran que la terapia antibiótica de la FQ evoluciona más rápidamente que las recomendaciones reflejadas en las guías clínicas. Es necesario evaluar estos nuevos esquemas con estudios clínicos, así como con otros fármacos inhalados de reciente aparición y su papel en los esquemas existentes (AU)

Antibiotic prescription patterns in Spanish cystic fibrosis patients: results from a national multicenter study.

OBJECTIVE: Information about antibiotic prescription patterns for cystic fibrosis (CF) patients and, specifically, about inhaled treatment strategies for their management is lacking in Spain due to the absence of a national patient registry. In this study we present data about antibiotic prescription in the Spanish CF context that were obtained in a multicenter study, being inhaled treatment strategies the special focus of this work. METHODS: Twenty-four specialized CF units (12 adult, 12 pediatric) from 17 tertiary-care hospitals covering all Spanish Autonomous Communities provided sputa and clinical data from 15 consecutive patients. Data about antibiotic and non-antibiotic therapies prescribed to these patients during the year prior inclusion (2013) were retrospectively collected. RESULTS: The multicenter study included 341 CF patients from all age groups and clinical status. The prevalence of oral, inhaled and intravenous therapies was 89% (n = 302), 80% (n = 273) and 31% (n = 105), respectively. The most prevalent oral agents were ciprofloxacin (n = 177, 59%), cotrimoxazole (n = 109, 36%) and amoxicillin-clavulanate (n = 99, 33%), whereas ceftazidime (n = 53, 50%), tobramycin (n = 43, 41%) and meropenem (n = 41, 49%) were the most prevalent intravenous ones. Two or more different inhaled antibiotics were administered to 67 patients (24%), 51 of them receiving 2 drugs continuously in alternating schemes. Nebulization of intravenous specific antibiotics was common (n = 39) and, in some cases, was used for maintenance purposes. CONCLUSIONS: These results show that the treatment of CF patients is evolving more rapidly than clinical consensus guidelines. Clinical trials evaluating new specific inhaled combinations and new alternative treatment regimes of the existing ones are needed.

Objetivos: Existen actualmente pocos datos acerca de las pautas de tratamiento antimicrobiano administradas a los pacientes con fibrosis quística (FQ) en España, sobre todo en lo que se refiere a la antibioterapia inhalada. Esta escasez de conocimiento se debe principalmente a la ausencia de un registro nacional de datos de pacientes. En 2013 se llevó a cabo el primer estudio multicéntrico español focalizado en la microbiología de la FQ. En este trabajo presentamos los patrones de prescripción de antimicrobianos administrados durante un año a los pacientes incluidos en dicho estudio.Métodos: Se contó con la participación de 24 unidades de FQ (12 de adultos y 12 de pediatría) procedentes de 17 hospitales españoles. Cada unidad reclutó a 15 pacientes de manera consecutiva, que aportaron muestras respiratorias y datos clínicos. Se recogieron de manera retrospectiva los tratamientos antibióticos y no antibióticos administrados a estos pacientes durante el año previo a su inclusión en el estudio.Resultados: Se incluyeron 341 pacientes con FQ de todos los rangos de edad y de gravedad clínica. La prevalencia de antibioterapia oral, inhalada e intravenosa fue del 89% (n = 302), 80% (n = 273) y 31% (n = 105), respectivamente. Los fármacos administrados con mayor frecuencia por vía oral fueron ciprofloxacino (n = 177, 59%), cotrimoxazol (n = 109, 36%) y amoxicilina-clavulánico (n = 99, 33%), siendo ceftazidima (n = 53, 50%), tobramicina (n = 43, 41%) y meropenem (n = 41, 49%) los más frecuentes por vía intravenosa. Se administraron dos o más antibióticos por vía inhalada a 67 pacientes (24%), habiendo recibido 51 de ellos 2 antibióticos simultáneamente de manera rotatoria. La nebulización de antibióticos con formulación intravenosa fue una práctica común (n = 39) y, en algunos casos, se utilizó durante un tiempo prolongado como terapia de mantenimiento.Conclusiones: Los esquemas de tratamiento observados en este estudio demuestran que la terapia antibiótica de la FQ evoluciona más rápidamente que las recomendaciones reflejadas en las guías clínicas. Es necesario evaluar estos nuevos esquemas con estudios clínicos, así como con otros fármacos inhalados de reciente aparición y su papel en los esquemas existentes.

Consenso español para la prevención y el tratamiento de la infección bronquial por Pseudomonas aeruginosa en el paciente con fibrosis quística / Spanish Consensus on the Prevention and Treatment of Pseudomonas aeruginosa Bronchial Infections in Cystic Fibrosis Patients

Pseudomonas aeruginosa es el patógeno más importante en la infección broncopulmonar en fibrosis quística (FQ). Solo se erradica en la infección inicial, mientras que la reducción de su carga bacteriana es el objetivo terapéutico en la infección crónica y exacerbaciones. El cribado neonatal y la farmacociné- tica/farmacodinámica han cambiado el manejo del paciente con FQ. Se debe realizar un seguimiento microbiológico en los pacientes sin infección por P. aeruginosa. En la infección inicial se recomienda tratamiento inhalado (28 días) con colistina (0,5-2 MU/8 h), tobramicina (300 mg/12 h) o aztreonam (75 mg/8 h) con o sin ciprofloxacino oral (15-20 mg/kg/12 h, 2-3 semanas). En la infección crónica se recomienda solo vía inhalada en tratamiento continuo con colistina, o en ciclos on-off de 28 días con tobramicina o aztreonam. Durante las exacerbaciones leves-moderadas se recomienda tratamiento oral (ciprofloxacino, 2-3 semanas) y en las graves tratamiento intravenoso (-lactámico asociado a un aminoglicósido o una fluoroquinolona). Estudios futuros sustentarán la rotación y nuevas combinaciones de antimicrobianos. Se deben establecer también medidas epidemiológicas que eviten nuevas infecciones y la transmisión cruzada de P. aeruginosa

Pseudomonas aeruginosa is the main pathogen in bronchopulmonary infections in cystic fibrosis (CF) patients. It can only be eradicated at early infection stages while reduction of its bacterial load is the therapeutic goal during chronic infection or exacerbations. Neonatal screening and pharmacokinetic/pharmacodynamic knowledge has modified the management of CF-patients. A culture based microbiological follow-up should be performed in patients with no infection with P. aeruginosa. At initial infection, inhaled colistin (0,5-2 MU/tid), tobramycin (300 mg/bid) or aztreonam (75 mg/tid) with or without oral ciprofloxacin (15-20 mg/kg/bid, 2-3 weeks) are recommended. In chronic infections, treatment is based on continuous administration of colistin or with a 28-day on-off regimen with tobramycin or aztreonam. During mild-moderate exacerbations oral ciprofloxacin (2-3 weeks) can be administered while serious exacerbations must be treated with intravenous combination therapy (beta-lactam with an aminoglycoside or a fluoroquinolone). Future studies will support antibiotic rotation and/or new combination therapies. Epidemiological measures are also recommended to avoid new P. aeruginosa infections and "patient-to-patient transmission" of this pathogen

Spanish consensus on the prevention and treatment of Pseudomonas aeruginosa bronchial infections in cystic fibrosis patients.

Pseudomonas aeruginosa is the main pathogen in bronchopulmonary infections in cystic fibrosis (CF) patients. It can only be eradicated at early infection stages while reduction of its bacterial load is the therapeutic goal during chronic infection or exacerbations. Neonatal screening and pharmacokinetic/pharmacodynamic knowledge has modified the management of CF-patients. A culture based microbiological follow-up should be performed in patients with no infection with P.aeruginosa. At initial infection, inhaled colistin (0,5-2MU/tid), tobramycin (300mg/bid) or aztreonam (75mg/tid) with or without oral ciprofloxacin (15-20mg/kg/bid, 2-3weeks) are recommended. In chronic infections, treatment is based on continuous administration of colistin or with a 28-day on-off regimen with tobramycin or aztreonam. During mild-moderate exacerbations oral ciprofloxacin (2-3weeks) can be administered while serious exacerbations must be treated with intravenous combination therapy (beta-lactam with an aminoglycoside or a fluoroquinolone). Future studies will support antibiotic rotation and/or new combination therapies. Epidemiological measures are also recommended to avoid new P.aeruginosa infections and "patient-to-patient transmission" of this pathogen.

Paediatric patients with a tracheostomy: a multicentre epidemiological study.

Changes in the indications for tracheostomy in children have led to the progressively greater involvement of the paediatric pulmonologist in the care of these patients. The aim of this study was to review the current profile of tracheostomised children in Spain. We undertook a longitudinal, multicentre study over 2 yrs (2008 and 2009) of all patients aged between 1 day and 18 yrs who had a tracheostomy. The study, involving 18 Spanish hospitals, included 249 patients, of whom 150 (60.2%) were <1 yr of age. The main indications for the procedure were prolonged ventilation (n=156, 62.6%), acquired subglottic stenosis (n=34, 13.6%), congenital or acquired craniofacial anomalies (n=25, 10%) and congenital airway anomalies (n=24, 9.6%). The most frequent underlying disorders were neurological diseases (n=126, 50.6%) and respiratory diseases (n=98, 39.3%). Over the 2-yr study period, 92 (36.9%) children required ventilatory support, and decannulation was achieved in 59 (23.7%). Complications arose in 117 patients (46.9%). Mortality attributed to the underlying condition was 12.5% and that related directly to the tracheostomy was 3.2%. Respiratory complexity of tracheostomised children necessitates prolonged, multidisciplinary follow-up, which can often extend to adulthood.

Paroxysmal activity and seizures associated with sleep breathing disorder in children: a possible overlap between diurnal and nocturnal symptoms.

PURPOSE: Sleep breathing disorders (SBD) can trigger paroxysmal events. We recently found a higher percentage of paroxysmal activity (PA) in a sample of Italian children with obstructive sleep apnea syndrome (OSAS) and no history of epilepsy. The signs of nocturnal seizures can overlap with sleep respiratory events. The aim of this study was to confirm the high frequency of PA or interictal epileptiform discharges (IEDs) during sleep in a cohort of Spanish children who underwent polysomonography (PSG) for suspected SBD and to ascertain the eventual presence of seizures by means of a video-PSG with an extended electroencephalogram (EEG). METHODS: PSG was performed in a population of children with no previous history of epileptic seizures recruited prospectively for suspected OSAS from January to December 2007. Recordings included at least 13 EEG channels. RESULTS: In total, 25 children (mean age, 6.6 ± 3.8 years, 14 males) were diagnosed with SBD, and 4/25 (16%) children met the criteria for OSAS and epilepsy, with IEDs and/or seizures during sleep. We diagnosed benign epilepsy with centro-temporal spikes in 2 cases, partial symptomatic epilepsy in one, and nocturnal frontal lobe epilepsy in another, while we found PA in 2 patients. The body mass index and the apnea-hypopnea index were significantly higher in children without IEDs/PA. CONCLUSIONS: Our study demonstrated a close relationship between pediatric SBD, PA during sleep, and epilepsy that may aggravate the prognosis of SBD. Due to the possibility of an overlap of symptoms, a video-PSG with extended EEG montage is necessary.

[Nontuberculous mycobacterial infection in patients with cystic fibrosis: a multicenter prevalence study]. / Estudio multicéntrico de prevalencia de micobacterias ambientales en pacientes con fibrosis quística.

OBJECTIVE: To determine the prevalence of nontuberculous mycobacterial infection in patients with cystic fibrosis. PATIENTS AND METHODS: We performed a prospective study in which patients with cystic fibrosis were followed for 2 years; the patients were recruited from specialized units and were all over 6 years old. Sputum samples collected every 6 months were stained with auramine-rhodamine and cultures were prepared with a liquid and a solid medium. When stains or cultures were positive for nontuberculous mycobacteria, 1 or 2 additional sputum samples were obtained from the patients, who were monitored closely to assess the need for specific treatment. We assessed the following clinical variables: age, sex, presence of pancreatic insufficiency, use of aerosol antibiotic therapy, and long-term azithromycin and inhaled or oral corticosteroid therapies. RESULTS: A total of 220 patients (119 women) with a mean age of 22.62 years (range, 6-74 years) were enrolled; of these 23.6% were receiving azithromycin. We prepared 1303 sputum samples for mycobacterial growth (range per patient, 4-68 samples); 65 samples from a total of 17 patients (7.72%) were positive: 17 by auramine-rhodamine staining and 48 by culture. Eighty-eight culture samples were contaminated and Mycobacterium tuberculosis was not isolated in any of the cases. The mycobacteria isolated were M avium complex (n=10), M abscessus (n=6), and M fortuitum (n=1). Two or more positive cultures were obtained in 9 patients, 5 of whom experienced clinical deterioration and were prescribed specific treatment. No significant differences in clinical variables were found between patients with nontuberculous mycobacteria and those without. CONCLUSIONS: The prevalence of nontuberculous mycobacterial infection in patients with cystic fibrosis was not very high (7.72%), perhaps because azithromycin interfered with the growth of these bacteria. Patients with repeat isolations of mycobacteria should be monitored closely.

Estudio multicéntrico de prevalencia de micobacterias ambientales en pacientes con fibrosis quística / Nontuberculous mycobacterial infection in patients with cystic fibrosis: a multicenter prevalence study

OBJETIVO: Evaluar la prevalencia de micobacteriasambientales (MA) en pacientes con fibrosis quística (FQ).PACIENTES Y MÉTODOS: Se ha realizado un estudioprospectivo de 2 años de duración en pacientes con FQmayores de 6 años, procedentes de 6 unidades monográficas.En las muestras respiratorias, recogidas cada 6 meses, seefectuó una tinción de auramina-rodamina, además decultivos en medios sólido y líquido. Si se detectaba unatinción o cultivo positivo para MA, se recogían 1 o 2 esputosmás y se hacía un seguimiento estricto para valorar lanecesidad de tratamiento específico. Se consideraron lassiguientes variables clínicas: edad, sexo, insuficienciapancreática, diabetes, uso de aerosolterapia antibiótica yde azitromicina de forma continua, tratamientos concorticoides inhalados o por vía oral de forma prolongada.RESULTADOS: Participaron en el estudio 220 pacientes (119mujeres), con una edad media de 22,62 años (rango: 6-74). El23,6% recibía azitromicina. Se cultivaron para la detecciónde micobacterias 1.303 muestras de esputo (rango porpaciente: 4-68), de las que la tinción de auramina fue positivaen 17 casos y el cultivo en 48, correspondientes a 17 pacientes(7,72%). En 88 muestras el cultivo estaba contaminado. Enningún caso se aisló Mycobacterium tuberculosis. Las MAaisladas fueron: M. avium complex (n = 10), M. abscessus (n = 6)y M. fortuitum (n = 1). Cinco de los 9 pacientes que presentaronmás de un aislamiento tuvieron deterioro clínico y se les indicótratamiento específico. No hubo diferencias entre las variablesclínicas de los pacientes con y sin aislamientos de MA.CONCLUSIONES: La prevalencia de MA en pacientes conFQ no fue muy alta (7,72%), quizá debido a la interferenciade la azitromicina sobre el crecimiento de MA. Hay quevigilar estrechamente a los pacientes con aislamientosrepetidos

OBJECTIVE: To determine the prevalence of nontuberculousmycobacterial infection in patients with cystic fibrosis.PATIENTS AND METHODS: We performed a prospective study inwhich patients with cystic fibrosis were followed for 2 years; thepatients were recruited from specialized units and were all over6 years old. Sputum samples collected every 6 months were stainedwith auramine-rhodamine and cultures were prepared with a liquidand a solid medium. When stains or cultures were positive fornontuberculous mycobacteria, 1 or 2 additional sputum sampleswere obtained from the patients, who were monitored closely toassess the need for specific treatment. We assessed the followingclinical variables: age, sex, presence of pancreatic insufficiency, useof aerosol antibiotic therapy, and long-term azithromycin andinhaled or oral corticosteroid therapies.RESULTS: A total of 220 patients (119 women) with a mean ageof 22.62 years (range, 6-74 years) were enrolled; of these 23.6%were receiving azithromycin. We prepared 1303 sputum samplesfor mycobacterial growth (range per patient, 4-68 samples);65 samples from a total of 17 patients (7.72%) were positive: 17 byauramine-rhodamine staining and 48 by culture. Eighty-eightculture samples were contaminated and Mycobacteriumtuberculosis was not isolated in any of the cases. The mycobacteriaisolated were M avium complex (n=10), M abscessus (n=6), andM fortuitum (n=1). Two or more positive cultures were obtainedin 9 patients, 5 of whom experienced clinical deterioration andwere prescribed specific treatment. No significant differences inclinical variables were found between patients with nontuberculousmycobacteria and those without.CONCLUSIONS: The prevalence of nontuberculous mycobacterialinfection in patients with cystic fibrosis was not very high(7.72%), perhaps because azithromycin interfered with thegrowth of these bacteria. Patients with repeat isolations ofmycobacteria should be monitored closely

[Patients with cystic fibrosis managed at the cystic fibrosis units of Madrid: cross-sectional study of 387 subjects]. / Pacientes con fibrosis quística atendidos en las unidades de fibrosis quística de la Comunidad de Madrid: estudio transversal de 387 casos.

BACKGROUND AND OBJECTIVE: Our objective was to describe the clinical and genetics features of patients with cystic fibrosis (CF) attended in Madrid. PATIENTS AND METHOD: This was a descriptive, cross-sectional study of CF patients attended during 2001. Demographic, genetic, anthropometric, pancreatic insufficiency, diabetes mellitus, Pseudomonas aeruginosa colonization, lung function and body mass index (BMI) (z score) data were recorded and compared with the American CF Registry. RESULTS: 387 patients were included, most of them living in Madrid (n = 247 [63%]), 209 males (54%), with a mean age (SD) of 15.15 (10.42) years (younger than 18 years, 248, 64.24%). F508del was the most common mutation (52.8% of chromosomes) with 104 homozygous patients. Pancreatic insufficiency was present in 310 subjects (80.1%), diabetes mellitus in 30 (7.8%) and P. aeruginosa colonization in 126 (33.1%). Lung function was measured in 309 patients: mean of FEV1 and FVC predicted values (SD) was 82.5 (27.11) and 89.32 (21.89), respectively. The mean BMI z score was 0.0796 (1.18). CONCLUSIONS: CF patients from Madrid have a good nutritional status, less P. aeruginosa colonization, less pancreatic insufficiency and better lung function than those of the American CF Registry. The lower prevalence of homozygous F508del in our population may explain, at least partly, our findings.

[Home intravenous antibiotic treatments in cystic fibrosis units of Madrid]. / Tratamiento antibiótico intravenoso domiciliario en las unidades de fibrosis quística de la Comunidad de Madrid.

BACKGROUND AND OBJECTIVE: A descriptive study of the home intravenous antibiotic treatment (HIVAT) course in cystic fibrosis (CF) units of Madrid in an 18 month period. Different patient features were recorded, antibiotherapy, intravenous access, complications and their resolutions. We accessed the improvement of the pulmonary function, forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) at the end of the treatment. PATIENTS AND METHOD: For an 18 months period (January 2002-June 2003) the patients with CF who received HIVAT and fulfilled the previously fixed criteria were included. The next clinic variables were collected: age, sex, bacterial colonization of respiratory tree, pancreatic function and pulmonary function in steady phase, before and after HIAT. RESULTS: 56 patients, 31 male and 25 female, were given 90 courses of HIAT (34 patients received only one course). Mean age was 20.06 (8.07) years. 57.1% of the patients were colonized by Pseudomonas aeruginosa. The most frequently used antibiotics were ceftazidime and tobramycin. Courses of treatment lasted a mean of 4.08 (5.09) days inpatient and 11.89 (4.96) at home. In 87.7% of the course were used the intravenous cannulae, Port-a-cath in 6.7% and Venocath in 7.8%. The intravenous access was replaced, in the 64.4% of the cases, by the nurse of the CF Unit, in the 21.4% in the emergency room of the nearest hospital and in 11.9% in primary care center. Three occasions skin reactions were reported. The parameters of pulmonary function improved significatively after HIVAT. CONCLUSIONS: The HIVAT is a therapeutic option that, following predetermined inclusion criteria, has a low complication rate and improves pulmonary function.

Pacientes con fibrosis quística atendidos en las unidades de fibrosis quística de la Comunidad de Madrid: estudio transversal de 387 casos / Patients with cystic fibrosis attending at the cystic fibrosis units of Madrid: cross-sectional study of 387 subjects

FUNDAMENTO Y OBJETIVO: Establecer las características clínicas y genéticas de los pacientes con fibrosis quística (FQ) de la Comunidad de Madrid. PACIENTES Y MÉTODO: Estudio descriptivo y transversal de los pacientes con FQ atendidos regularmente durante el año 2001. Se recogieron datos demográficos, genéticos, antropométricos, presencia de insuficiencia pancreática, diabetes mellitus y colonización por Pseudomonas aeruginosa, valores espirométricos y de índice de masa corporal (puntuación Z), y se compararon con los del registro americano del mismo año. RESULTADOS: Se incluyó a 387 pacientes -209 varones (54 por ciento)-, la mayoría residentes en Madrid (n = 247 [63 por ciento]), con una edad media (DE) de 15,15 (10,42) años (menores de 18 años, 248 [64,24 por ciento]). La mutación más frecuente fue la F508del (52,8 por ciento de los cromosomas), con 104 homocigotos (28,5 por ciento). Presentaron insuficiencia pancreática 310 (80,1 por ciento); diabetes mellitus, 30 (7,8 por ciento), y colonización por P. aeruginosa, 126 (33,1 por ciento). La función pulmonar se midió en 309 pacientes. La media del porcentaje predicho del volumen espiratorio forzado en el primer segundo fue de 82,5 (27,11) y la de la capacidad vital forzada de 89,32 (21,89). La media de la puntuación Z del índice de masa corporal fue de -0,0796 (1,18). La peor función pulmonar correspondió a los pacientes colonizados por P. aeruginosa, con peor estado de nutrición y de mayor edad. La insuficiencia pancreática, la edad y la peor función respiratoria (volumen espiratorio forzado en el primer segundo) determinaron el peor estado nutricional. CONCLUSIONES: Los pacientes con FQ de nuestra comunidad tienen buen estado nutricional, menos colonización por P. aeruginosa e insuficiencia pancreática y mejor función pulmonar que los pacientes del registro americano. La menor presencia de la mutación F508del en homocigosis podría ser la causa, al menos en parte, de estos resultados (AU)

Hemoptisis por tuberculosis pulmonar y su tratamiento con aretiografía bronquial y embolización / Hemoptisis produced by lung tuberculosisi and its treatment by bronchial arteriography and embolization

El presente trabajo es un análisis de la experiencia con arteriografía bronquial y embolización a los pacientes con hemoptisis por tuberculosis pulmonar en un período de 10 años, de junio de 1989 a mayo de 1999. Se trata de un estudio retrospectivo, transversal y descriptivo obtenido de los archivos clínico y de radiología invasiva del hospital con un total de 74 expedientes. Se le realizaron 91 arteriografías bronquiales y un total de 83 embolizaciones. El sexo más frecuente fue el masculino (61 por ciento), con predominio de mayores de 65 y menores de 25 años. En el sexo femenino la mayor incidencia fue en el grupo de 56 a 65 años. Doce procedimientos se realizaron con carácter de urgencia (13 por ciento). Las lesiones más frecuentes fueron la extravasación y las fístulas arterio-venosas. En 64 casos no se reportaron recurrencias, mientras que en 10 hubo 15 episodios de recurrencia de la hemoptisis; de éstos, en 12 ocurrió antes de los 30 días y en los 3 restantes entre el primero y el tercer mes. Asimismo, 12 de los 15 se observaron en varones y 7 después de los 65 años. Se concluye que la efectividad de la embolización por la arteria bronquial es efectiva en el 86 por ciento de los casos y el tratamiento de la recurrencia de la hemoptisis tuvo una efectividad del 50 por ciento. El tratamiento quirúrgico se debe reservar para los casos de recidiva frecuente y con hemoptisis masiva.

Frecuencia de uso y tipo de antimicrobianos utilizados en la unidad de especialidades odontológicas en el periodo comprendido de enero-marzo de 1999: estudio prospectivo / Frequency and class of antibiotic employment in the Odontologic Specialties Unit of the Mexican Army for the period january-march 1999: a prospective trial

Se hizo una recopilación de las recetas emitidas por los cirujanos dentistas de la clínica, que es una unidad completa, de asistencia externa, que cuenta con todas las especialidades de odontología, en el período comprendido de enero a marzo de 1999, con el objeto de conocer los requerimientos de empleo de medicamentos antimicrobianos. Se encontró que en el período señalado se prescribieron un total de 2,873 recetas, de las cuales 1,592 (55.4 por ciento) incluyeron medicamentos antimicrobianos. Los departamentos con la mayor prescripción de esta clase fueron los de Urgencias y de Diagnóstico. Los antibióticos más empleados fueron los de las familia de los beta-lactámicos.

Abceso tuberculoso de psoas: informe de un caso / Tuberculous abscess of the psoas muscle: case report

La tuberculosis es un problema de salud pública, prevalente en México, las manifestaciones extrapulmonares son frecuentes. El psoas se afecta cuando hay ruptura de abscesos de columna toracolumbar (mal de Pott); la afección primaria es rara. Presentamos el caso clínico de un paciente joven, en quien se encontró por cirugía un absceso solitario, granulomatoso primario del psoas derecho, sin lesiones en otro sitio. La etiología tuberculosa fue la más probable, dado los datos clínicos, epidemiológicos, histopatológicos y de imágenes (ultrasonido, tomografía computada, resonancia magnética y gammagrafía). Se inició tratamiento con rifampicina, pirazinamida, etambutol e isoniacida, con buena respuesta durante el seguimiento

Megaesófago chagásico. Informe de un caso / Megaesophagus by chagas disease. Case report

El Trypanosoma cruzi es un parásito protozoario que causa la enfermedad de Chagas, que es endémica en México. Los riesgos de infección están relacionados a la exposición a insectos que albergan a T. cruzi o por transfusión sanguínea de un donador infectado. La enfermedad de Chagas es uno de los problemas de salud pública más importantes en México y Sudamérica. La migración de zonas rurales a zonas urbanas ha contribuido a diseminar la enfermedad. Los blancos principales de la enfermedad dentro del cuerpo son: el corazón, el aparato digestivo y el sistema nervioso. En la fase aguda de la enfermedad el parásito responsable puede ser identificado por un examen sanguíneo directo