[Characteristics of patients with invasive pneumococcal disease requiring admission to intensive care units]. / Características de los pacientes con enfermedad neumocócica invasora que requieren ingreso en la unidad de cuidados intensivos.

INTRODUCTION: Patients with invasive pneumococcal disease (IPD) may require admission into paediatric intensive care units (PICU). The aim of this study is to analyse the epidemiological, clinical, and microbiological characteristics associated with IPD that may require admission to the PICU. MATERIAL AND METHODS: A prospective study was conducted on cases of IPD diagnosed in three Paediatric Hospitals in Barcelona between January 2012 and June 2016. An analysis was made of the associations between the admission to PICU and the epidemiological, clinical, and microbiological variables. RESULTS: A total of 263 cases with IPD were included, of which 19% (n = 50) required admission to PICU. Patients with septic shock (7; 100%), meningitis (16; 84.2%), and those with complicated pneumonia (23; 15.2%) were admitted to the PICU. The most frequent complications were pulmonary (35.2%) and neurological (39.5%). The ratio between admission and non-admission to PICU was 4.7 times higher in subjects with an underlying disease. The serotypes associated with PICU admission were 19A (23% of the total of this serotype), serotype 14 (20%), serotype 3 (17%), and serotype 1 (12.5%). CONCLUSIONS: IPD required PICU admission in cases of septic shock and meningitis, and less so with complicated pneumonia. The percentage of admissions is greater in children with an underlying disease. Admission into the PICU involves a longer stay, complications during the acute phase, as well as sequelae, particularly neurological ones. The serotypes of the patients that were admitted to PICU were predominantly vaccine serotypes.

Tos ferina en España. Situación epidemiológica y estrategias de prevención y control. Recomendaciones del Grupo de Trabajo de Tos ferina / Whooping cough in Spain. Current epidemiology, prevention and control strategies. Recommendations by the Pertussis Working Group

En los últimos años se está observando una reemergencia de la tos ferina en los países con amplias coberturas vacunales, con la aparición de brotes importantes. Este aumento de la incidencia tiene una distribución por edades bipolar: en los lactantes menores de 6meses, que por su edad no han iniciado la vacunación o no han completado la primovacunación, y en los adolescentes y adultos por la disminución de su inmunidad, vacunal o natural, con el tiempo transcurrido desde la inmunización o el padecimiento de la enfermedad. Estos cambios epidemiológicos justifican la adopción de nuevas estrategias vacunales con la finalidad de proteger al lactante pequeño y disminuir la incidencia de la enfermedad en toda la población. La vacunación del adolescente y del adulto debería ser prioritaria; en el primer caso solo supone cambiar la vacuna dT por la dTpa, con un coste adicional pequeño. La vacunación del adulto puede ser más difícil de implementar, pero de la misma forma que en muchos países se revacuna cada 10años frente a la difteria y el tétanos (con la vacuna dT), debería hacerse también frente a la tos ferina (con la vacuna dTpa). La estrategia que puede tener un impacto más importante sobre la incidencia de la tos ferina en el lactante es la vacunación de las personas con quienes convive o va a convivir, lo que se conoce como estrategia del nido. Recientemente, en algunos países se ha introducido también la vacunación de la embarazada, a partir de las 20semanas de gestación, como la forma más efectiva para proteger al recién nacido (AU)

A large increase of pertussis incidence has been observed in recent years in countries with high vaccination coverage. Outbreaks of pertussis are increasingly being reported. The age presentation has a bipolar distribution: infants younger 6months that have not initiated or completed a vaccination schedule, and adolescents and adults, due to the lost of natural or vaccine immunity over time. These epidemiological changes justify the need to adopt new vaccination strategies in order to protect young infants and to reduce pertussis incidence in all age groups. Adolescents and adults immunization must be a priority. In the first group, strategy is easy to implement, and with a very low additional cost (to replace dT vaccine by dTap one). Adult vaccination may be more difficult to implement; dT vaccine decennial booster should be replaced by dTap. The immunization of household contacts of newborn infants (cocooning) is the strategy that has a most important impact on infant pertussis. Recently, pregnant women vaccination (after 20weeks of gestation) has been recommended in some countries as the most effective way to protect the newborn (AU)

[Whooping cough in Spain. Current epidemiology, prevention and control strategies. Recommendations by the Pertussis Working Group]. / Tos ferina en España. Situación epidemiológica y estrategias de prevención y control. Recomendaciones del Grupo de Trabajo de Tos ferina.

A large increase of pertussis incidence has been observed in recent years in countries with high vaccination coverage. Outbreaks of pertussis are increasingly being reported. The age presentation has a bipolar distribution: infants younger 6months that have not initiated or completed a vaccination schedule, and adolescents and adults, due to the lost of natural or vaccine immunity over time. These epidemiological changes justify the need to adopt new vaccination strategies in order to protect young infants and to reduce pertussis incidence in all age groups. Adolescents and adults immunization must be a priority. In the first group, strategy is easy to implement, and with a very low additional cost (to replace dT vaccine by dTap one). Adult vaccination may be more difficult to implement; dT vaccine decennial booster should be replaced by dTap. The immunization of household contacts of newborn infants (cocooning) is the strategy that has a most important impact on infant pertussis. Recently, pregnant women vaccination (after 20weeks of gestation) has been recommended in some countries as the most effective way to protect the newborn.

Increase in metabolic syndrome as defined by ATPIII from 1992-1993 to 2002-2003 in a Mediterranean population.

This paper presents the results of a study that aimed to describe the prevalence and evolution of metabolic syndrome (MetS) in the Mediterranean population of Catalonia, Spain, between 1992-1993 and 2002-2003 by applying the National Cholesterol Education Program's Adult Treatment Panel III (ATPIII) and International Diabetes Federation (IDF) definitions. Data from two cross-sectional population-based surveys were used (ENCAT 1992-1993 [n = 820] and 2002-2003 [n = 1,384]). Applying IDF definitions, MetS tended to increase (P = 0.08), from 25% in 1992-1993 to 28.5% in 2002-2003. Applying ATPIII definitions, MetS prevalence was lower, and it increased significantly (P < 0.001) from 18.4% in 1992-1993 to 24.8% in 2002-2003. MetS prevalence is high and has increased significantly in the last decade in Catalonia.

[Distribution of the serum concentration of beta-carotene, retinol and alpha-tocopherol in a representative sample of the adult population of Catalonia (Spain)]. / Distribución de la concentración sérica de beta-caroteno, retinol y alpha-tocoferol en una muestra representativa de la población adulta de Cataluña.

BACKGROUND: Some vitamins (beta-carotene, retinol and alpha-tocopherol) have been used in the prevention of neurovegetative diseases, immunodeficiencies and cancer because of the possible relation with the etiology and physiopathology of these disorders. Nevertheless, the serum values of such micronutrients in the population have not been described. The purpose of this study was to determine the serum concentrations of beta-carotene, retinol and alpha-tocopherol in the Catalan population and to examine the prevalence of deficits. METHOD: We studied 343 individuals from a representative sample of individuals aged 18 to 75 years who had participated in the Nutritional Status of the Catalan Population (Spain) 1992-1993 study. Serum concentrations of beta-carotene, retinol and alpha-tocopherol were analysed. RESULTS: The serum concentration of beta-carotene was 0.39 and 0.49 micromol/l in men and women, respectively, and the prevalence of deficits was 62% in men and 54% in women. The serum concentration of retinol was lower in women (1.68 mol/l) than in men (1.98 mol/l) but no deficit was detected for this vitamin. 12% of women aged 18 to 34 years showed a marginal deficit of alpha-tocopherol. CONCLUSION: Our study reveals good nutritional status of retinol and alpha-tocopherol in the sample studied. However, a high prevalence of suboptimal concentrations of beta-carotene was detected, which should be corrected increasing the intake of fruits and vegetables.

Distribución de la concentración sérica de -caroteno, retinol y -tocoferol en una muestra representativa de la población adulta de cataluña / Distribution of the serum concentration of -carotene, retinol and -tocopherol in a representative sample of the adult population of Catalonia (Spain)

FUNDAMENTO: Ciertas vitaminas ( -caroteno, retinol, -tocoferol) se han utilizado en la prevención de enfermedades neurovegetativas, inmunodeficiencias y cánceres por su posible relación con su etiopatogenia. Sin embargo, no se han descrito los valores séricos de dichos micronutrientes en la población. El objetivo de este estudio es describir la concentración sérica de caroteno, retinol, y -tocoferol en la población catalana y determinar la prevalencia de déficit nutricional de estos micronutrientes. MÉTODO: Se obtuvo una submuestra de la muestra representativa de 18-75 años de edad que participó en el Estudio del Estado Nutricional de la Población Catalana (1992-1993). Se determinó la concentración sérica de -caroteno, retinol y -tocoferol. RESULTADOS: La concentración sérica de -caroteno fue de 0,39 y 0,49 µmol/l en varones y mujeres, respectivamente, y la prevalencia de déficit fue del 62 por ciento en los varones y del 54 por ciento en las mujeres. La concentración sérica de retinol fue superior en varones (1,98 µmol/l) que en mujeres (1,68 µmol/l) y no se detectó déficit para esta vitamina. En las mujeres de 18 a 34 años de edad, un 12 por ciento presenta un déficit marginal de -tocoferol. CONCLUSIONES: Se observa un buen estado nutricional de retinol y -tocoferol en la población estudiada. Sin embargo, destaca la elevada prevalencia de valores subóptimos de -caroteno en la población, los cuales deberían corregirse aumentando el consumo de frutas y verduras (AU)

[Distribution of the serum concentration of vitamin C, folic acid and vitamin B12 in a representative sample of the adult population of Catalonia (Spain)]. / Distribución de la concentración sérica de vitamina C, ácido fólico y vitamina B12 en una muestra representativa de la población adulta de Cataluña.

BACKGROUND: The subclinical deficiency of certain micronutrients (vitamin C, folic acid, vitamin B12) has been associated with disorders as cardiovascular diseases, cancer, cataracts, immunodepression and fetal neural tube defects. The purpose of this study was to determine the serum concentration of vitamin C, folic acid and vitamin B12 in the Catalan population and to examine the prevalence of deficits of these micronutrients. SUBJECTS AND METHOD: We studied a subsample of individuals (n = 378) from a representative sample of people aged 18 to 75 years who had participated in the study of the Nutritional Status of the Catalan Population (1992-93). Serum concentrations of vitamin C, folic acid and vitamin B12 were determined. RESULTS: The serum concentration of vitamin C was lower in men than in women. 4.6 and 0.5% subjects were found to have marginal and severe deficits of vitamin C, respectively. 4 and 1.6% subjects had marginal and severe deficits of folic acid, respectively. Folic acid deficit involved up to 12.9% women aged 18-34 years and up to 9.1% men within the same age group. Subjects who had a severe deficit of folic acid consumed more than 20 g/day of alcohol. The serum concentration of vitamin B12 was greater in women than in men. 1.9% individuals had a marginal deficit of this vitamin. CONCLUSION: The sample of individuals studied were found to have a correct nutritional status with regard to vitamin C, folic acid and vitamin B12. This may explain the lower incidence of cancer and ischemic heart disease associated with the Mediterranean diet.

Distribución de la concentración sérica de vitamina C, ácido fólico y vitamina B12 en una muestra representativa de la población adulta de cataluña / Distribution of the serum concentration of vitamin C, folic acid and vitamin B12 in a representative sample of the adult population of Catalonia (Spain)

FUNDAMENTO: El déficit subclínico de ciertos micronutrientes (vitamina C, ácido fólico, vitamina B12) se ha relacionado con afecciones degenerativas como las enfermedades cardiovasculares, el cáncer, las cataratas, el Parkinson, la inmunodepresión y con defectos del tubo neural en el feto. El objetivo de este estudio es describir la concentración sérica de vitamina C, ácido fólico y vitamina B12 en la población catalana y determinar la prevalencia de déficit nutricional de estos micronutrientes. SUJETOS Y MÉTODO: Se obtuvo una submuestra (n = 378) de la muestra representativa de 18-75 años de edad que participó en el Estudio del Estado Nutricional de la Población Catalana (1992-1993). Se determinó la concentración sérica de vitamina C, ácido fólico y vitamina B12. Resultados: La concentración sérica de vitamina C es menor en hombres que en mujeres. Un 4,6 y un 0,5 por ciento de la muestra presentan un déficit marginal e importante, respectivamente, de vitamina C. Un 4 y un 1,6 por ciento de la muestra tienen un déficit marginal e importante, respectivamente, de ácido fólico. En el grupo de edad de 18 a 34 años el déficit de ácido fólico asciende al 12,9 por ciento en mujeres y al 9,1 por ciento en varones. Los individuos con un déficit importante de ácido fólico consumen más de 20 g/día de alcohol. La concentración sérica de vitamina B12 es mayor en mujeres que en varones. Un 1,9 por ciento de la muestra presenta un déficit marginal. CONCLUSIONES: Este estudio pone de manifiesto un buen estado nutricional en vitamina C, ácido fólico y vitamina B12 de la población estudiada, lo cual explica probablemente la menor incidencia de cáncer y cardiopatía isquémica asociada a la dieta mediterránea (AU)