Allergic sensitization profiles among the foreign-born population in the north of Madrid.

Summary: Background. We assessed differences in allergic sensitization and clinical characteristics in a foreign-born population. Methods. Prospective, observational, descriptive study of patients aged > 12 years who were seen at the Department of Allergy, La Paz Hospital (Madrid, Spain), between January 2017 and December 2018. Patients were classified by geographical origin and ethnicity. Results. We included 150 patients (110 female) with a mean age of 38.38 years. Mean time to onset of respiratory symptoms after immigration was 8.47 years. Significant differences were observed between ethnic groups (p = 0.007). The most frequent sensitization was to grass pollen (75.2%), which was more common in South American patients (p = 0.005). We found that 59% of patients were sensitized to Cupressus and Olea pollen (higher in Asian patients, p = 0.032 and p = 0.049). Conclusions. Allergic sensitization in the foreign-born population was similar to that of the autochthonous population although differences between the groups were identified.

Adverse reaction with hexavalent vaccine: An unusual case

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Asthma Exacerbations in the Pediatric Emergency Department at a Tertiary Hospital: Association With Environmental Factors.

INTRODUCTION: Children with asthma experience recurrent respiratory symptoms and exacerbations due to multiple environmental factors. The aim of this study was to describe the prevalence and triggers of asthma exacerbations and their management in a cohort of pediatric patients attended in an emergency department (ED). METHODS: We performed an observational, retrospective, single-center study in the pediatric ED of Hospital Universitario La Paz, Madrid, Spain in 2015. Children with asthma exacerbations attending the ED were included after a thorough search using our institutional computer database. Pollen and atmospheric mold spore counts and pollution data were collected for that period from official websites. Multiple logistic regression was used to assess the association between daily pollution (NO2, PM10, ozone, pollen, and molds) and admissions to the ED because of asthma. RESULTS: During 2015, a total of 50 619 patients were attended in the ED of our hospital. Of these, 2609 (5%) were diagnosed with asthma exacerbation/bronchospasm. The patient had to be admitted to hospital in 21.7% of cases. The main triggers of asthma exacerbations were respiratory infection in 1841 cases (70.6%). A significant correlation was found between grass pollen counts and ED admissions (P<.0001). A positive correlation was also found between ED admissions and NO2 0.58 (95%CI, 0.02-0.87) and PM10 0.75 (95%CI, 0.31-0.93) (P<.05). CONCLUSION: Environmental factors such as grass pollen counts and pollution (NO2 and PM10) are associated with a higher frequency of admission to the ED.

Asthma exacerbations in the pediatric emergency department at a tertiary hospital: association with environmental factors

INTRODUCTION: Children with asthma experience recurrent respiratory symptoms and exacerbations due to multiple environmental factors. The aim of this study was to describe the prevalence and triggers of asthma exacerbations and their management in a cohort of pediatric patients attended in an emergency department (ED). METHODS: We performed an observational, retrospective, single-center study in the pediatric ED of Hospital Universitario La Paz, Madrid, Spain in 2015. Children with asthma exacerbations attending the ED were included after a thorough search using our institutional computer database. Pollen and atmospheric mold spore counts and pollution data were collected for that period from official websites. Multiple logistic regression was used to assess the association between daily pollution (NO2, PM10, ozone, pollen, and molds) and admissions to the ED because of asthma. RESULTS: During 2015, a total of 50 619 patients were attended in the ED of our hospital. Of these, 2609 (5%) were diagnosed with asthma exacerbation/bronchospasm. The patient had to be admitted to hospital in 21.7% of cases. The main triggers of asthma exacerbations were respiratory infection in 1841 cases (70.6%). A significant correlation was found between grass pollen counts and ED admissions (P<.0001). A positive correlation was also found between ED admissions and NO2 0.58 (95%CI, 0.02-0.87) and PM10 0.75 (95%CI, 0.31-0.93) (P<.05). CONCLUSION: Environmental factors such as grass pollen counts and pollution (NO2 and PM10) are associated with a higher frequency of admission to the ED

INTRODUCCIÓN: Los niños con asma presentan síntomas respiratorios y exacerbaciones recurrentes debido a múltiples factores ambientales. El objetivo de este estudio es describir la prevalencia y los desencadenantes de las exacerbaciones del asma y su manejo en una cohorte de pacientes pediátricos atendidos en un servicio de urgencias (SU). MÉTODOS: Se trata de un estudio observacional, retrospectivo, unicéntrico, dirigido en urgencias pediátricas del Hospital Universitario La Paz (Madrid, España) en 2015. Los pacientes con diagnóstico de exacerbación de asma fueron seleccionados a partir de una búsqueda informática. La información referente a niveles de pólenes, hongos y contaminación fue recogida en portales digitales oficiales. Se realizó una regresión logística múltiple para evaluar la asociación entre la contaminación diaria (determinada por los niveles NO2, PM10, O3, recuentos de polen y hongos) y las admisiones por asma en el SU. RESULTADOS: En el 2015 fueron atendidos en urgencias pediátricas de nuestro hospital 50.619 niños. De estos, 2.609 (5%) tenían diagnóstico de exacerbación asmática/broncoespasmo. El 21,7% de los casos requirió ingreso. Los principales desencadenantes fueron las infecciones (70,6%). La relación entre picos de polinización de gramíneas y admisión en urgencias fue significativa (p<10-4). Igualmente una correlación positiva fue obtenida entre ingresos en el SU y NO2 0,58 (95% 0,02 a 0,87) y PM10 0,75 (95% 0,31 a 0,93) (p < 0,05). CONCLUSIÓN: Factores ambientales como el recuento de polen de gramíneas y partículas contaminantes (NO2, PM10) se asocian con un mayor número de episodios de broncoespasmo atendidos en urgencias

Dermatitis caused by ingestion of chia seeds

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Anaphylaxis in Adolescent/Adult Patients Treated in the Emergency Department: Differences Between Initial Impressions and the Definitive Diagnosis.

OBJECTIVES: To contrast the initial suspected etiology of anaphylaxis with the postworkup diagnosis in patients attended at the emergency department (ED) of a tertiary-level hospital in Spain and to investigate the incidence, causes, and management of anaphylaxis. METHODS: We performed an observational study of patients aged more than 15 years who came to the ED with anaphylaxis between 2009 and 2010. All clinical records from the ED were reviewed. We recorded data on clinical management, the etiology proposed by the attending emergency physician, and the cause reported by the patient. The findings were compared with the diagnosis reached after the allergy workup. RESULTS: The incidence of anaphylaxis was 0.08%. The most common manifestation was skin-mucosal symptoms (98.3%). Anaphylaxis was diagnosed in the ED in only 44% of the cases, regardless of severity. Only 39.7% received epinephrine, which was administered more frequently when the ED physician diagnosed anaphylaxis, regardless of severity. A total of 60 patients were subsequently seen at the allergy department. The final etiology differed from the initial suspicion in the ED in 45% of cases. The frequency of anaphylaxis of uncertain origin decreased from 33.3% to 13.3%. After the allergy workup, drugs (41.7%) were considered the main cause of anaphylaxis, followed by food (25%). CONCLUSIONS: The incidence of anaphylaxis (0.08%) was double that estimated in the ED. Anaphylaxis is underdiagnosed. A correct diagnosis conditions the administration of epinephrine, regardless of the severity of symptoms. The real etiology of anaphylaxis should only be proposed after an allergy workup, which is recommended in all cases, as the real cause can differ considerably from the initial impression in the ED.

Anaphylaxis in adolescent/adult patients treated in the emergency department: differences between initial impressions and the definitive diagnosis

Objectives: To contrast the initial suspected etiology of anaphylaxis with the postworkup diagnosis in patients attended at the emergency department (ED) of a tertiary-level hospital in Spain and to investigate the incidence, causes, and management of anaphylaxis. Methods: We performed an observational study of patients aged more than 15 years who came to the ED with anaphylaxis between 2009 and 2010. All clinical records from the ED were reviewed. We recorded data on clinical management, the etiology proposed by the attending emergency physician, and the cause reported by the patient. The findings were compared with the diagnosis reached after the allergy workup. Results: The incidence of anaphylaxis was 0.08%. The most common manifestation was skin-mucosal symptoms (98.3%). Anaphylaxis was diagnosed in the ED in only 44% of the cases, regardless of severity. Only 39.7% received epinephrine, which was administered more frequently when the ED physician diagnosed anaphylaxis, regardless of severity. A total of 60 patients were subsequently seen at the allergy department. The final etiology differed from the initial suspicion in the ED in 45% of cases. The frequency of anaphylaxis of uncertain origin decreased from 33.3% to 13.3%. After the allergy workup, drugs (41.7%) were considered the main cause of anaphylaxis, followed by food (25%). Conclusions: The incidence of anaphylaxis (0.08%) was double that estimated in the ED. Anaphylaxis is underdiagnosed. A correct diagnosis conditions the administration of epinephrine, regardless of the severity of symptoms. The real etiology of anaphylaxis should only be proposed after an allergy workup, which is recommended in all cases, as the real cause can differ considerably from the initial impression in the ED (AU)

Objetivos: Contrastar la etiología sospechada de la anafilaxia con el diagnóstico tras el estudio alergológico en la población atendida en el Servicio de Urgencias (SU) de un hospital español de tercer nivel, y determinar incidencia, causas y manejo de la anafilaxia. Métodos: Se realizó un estudio observacional con pacientes mayores de 15 años de edad del SU con anafilaxia, entre 2009 y 2010. Se revisaron las historias clínicas del SU. Se recogieron manejo clínico, impresión etiológica del médico de Urgencias y paciente. Éstos se compararon con el diagnóstico final tras el estudio alergológico. Resultados: La incidencia de anafilaxia fue 0,08%. La manifestación más frecuente fue la cutáneo-mucosa (98,3%). Sólo se diagnosticó de anafilaxia al 44% de los casos, independientemente de la gravedad. El 39,7% recibió adrenalina, más frecuentemente si se diagnosticaban de anafilaxia, independientemente de la gravedad. Un total de 60 pacientes se atendieron posteriormente en Alergología. La etiología final cambió en un 45% del sospechado en el SU. El origen incierto se redujo de un 33.3% a un 13.3%. Tras el estudio alergológico, la causa más frecuente fueron los fármacos (41,7%), seguidos de los alimentos (25%). Conclusiones: La incidencia de anafilaxia, 0,08%, dobló la estimada en el SU. La anafilaxia está infradiagnosticada, mientras que el diagnóstico correcto condiciona la administración de adrenalina, independientemente de la gravedad. La verdadera etiología de la anafilaxia debería considerarse tras el estudio alergológico, que se debería recomendar a todos los pacientes, ya que puede ser diferente de la impresión en el SU (AU)

[Being a nurse today]. / Ser enfermera hoy.

This article was presented as a conference in Soria as part of the celebration of International Nursing Day 2000. The topic of this conference was the contribution Florence Nightingale made to the definition of the real essence of the nursing profession, and its evolution over the course of the century. The author included a discussion of these topics: What do nurses want? What do business managers want? What does society want and need? Finally, the author concluded that nursing is a lively profession which has tremendous desires to improve itself.