ABSTRACT
La borreliosis de Lyme es una enfermedad multiorgánica con afectación principalmente dermatológica, reumática, neurológica y cardiaca. La detección y el tratamiento en los primeros estadios son básicos para evitar su progresión. El pediatra, por tanto, debe conocer las manifestaciones clínicas de la enfermedad, así como establecer un correcto diagnóstico y tratamiento. Se exponen dos casos que incluyen las formas más frecuentes de presentación (AU)
Lyme borreliosis is a multisystem disease mainly dermatological, rheumatical, neurological and cardiological. The detection and treatment in the early stages are essential to prevent its progression. The pediatrician, therefore, must be aware of the clinical presentations of the disease as well as to establish a correct diagnosis and treatment. Two cases are presented involving the most common forms of presentation (AU)
Subject(s)
Humans , Male , Child , Adolescent , Lyme Disease/complications , Lyme Disease/diagnosis , Lyme Disease/therapy , Erythema/complications , Erythema/diagnosis , Erythema Chronicum Migrans/complications , Erythema Chronicum Migrans/diagnosis , Doxycycline/metabolism , Doxycycline/pharmacokinetics , Doxycycline/therapeutic use , Neck Pain/complications , Neck Pain/diagnosis , Neck Pain/etiology , Early DiagnosisABSTRACT
Introducción: El Streptococcus pyogenes es la causa bacteriana más importante de faringoamigdalitis aguda. Se analizó la validez de una prueba antigénica rápida para su diagnóstico, en consultas de atención primaria; asimismo se identificó el perfil clínico con mejor rendimiento diagnóstico, se cuantificó el uso innecesario de antibióticos cuando se utilizaba la prueba o solamente diagnóstico clínico y se determinó la sensibilidad microbiana a penicilina, eritromicina y clindamicina. Pacientes y métodos: Estudio descriptivo transversal a niños/as entre 2-14 años con amigdalitis y/o faringitis aguda atendidos en 5 consultas, desde enero de 2008 hasta mayo de 2010. Tras el diagnóstico clínico se realizó frotis faringoamigdalar con 2 hisopos: con el primero se realizó una prueba antigénica rápida y con el segundo cultivo y sensibilidad antibiótica, siendo su análisis ciego al resultado de la prueba. Se ha previsto una muestra de 546 personas y muestreo consecutivo. Resultados: Se incluyó a 192 pacientes. La prevalencia de Streptococcus pyogenes fue del 38,7%(IC del 95%: 31,4-45,7). La odinofagia y el exantema escarlatiniforme fueron más probables con cultivo positivo. En el 100% hubo sensibilidad a la penicilina, en el 97,3% a eritromicina y en el 86,3% a clindamicina. La especificidad de la prueba fue del 91,5% y el valor predictivo negativo del 91,5%. El 49,2% de quienes recibirían antibióticos por sospecha clínica serían tratados innecesariamente, disminuyendo al menos un 29,5% con la prueba. Conclusiones: La prueba permitió un uso más adecuado de antibióticos. Parece recomendable su uso en pediatría de atención primaria, sin necesidad de confirmación con cultivo cuando resulte negativa, en los centros con difícil acceso al laboratorio(AU)
Introduction: Streptococcus pyogenes is the most frequent bacterial cause of acute tonsillopharyngitis. The validity of the rapid antigen test was analysed for its diagnosis in a Paediatric Primary Care setting. The clinical profile with better diagnostic yield was also identified. The unnecessary use of antibiotics was quantified when the rapid antigen test or only the clinical diagnosis was used. The sensitivity of the assay to penicillin, erythromycin and clindamycin was also determined. Patients and methods: Cross-sectional study was conducted on children between 2 to 14 years with acute tonsillitis and/or pharyngitis seen in five Primary Care Centres, from January 2008to May 2010. After a clinical diagnosis, two swabs were taken for pharyngotonsillar smears: the first was used for a rapid antigen test, and the second one for a culture and a study of antibiotic sensitivity, with its analysis being blind to the rapid test result. A total sample of546 consecutive was envisaged and with consecutive sampling. Results: A total 192 patients were included. The prevalence of Streptococcus pyogenes was38.7% (95% CI: 31.4-45.7). Odynophagia and scarlatiniform rash were most likely with positive cultures, the Streptococcus pyogenes was sensitive to penicillin in 100%, to erythromycin in97.3% and to clindamycin in 86.3%. The specificity of the rapid antigen test was 91.5% and with a Negative Predictive Value of 91.5%. About half (49.2%) of those who would have receive antibiotics for clinical suspicion would have been treated unnecessarily, with this decreasing to at least in 29.5% when using the rapid antigen test. Conclusions: The rapid antigen test can lead to a better use of antibiotics. Its use in Paediatric Primary Health Care could be useful when, as when the result is negative, there would be no need to confirm by a culture, in those Health Centres with difficult access to laboratory(AU)
Subject(s)
Humans , Pharyngitis/microbiology , Tonsillitis/microbiology , Streptococcus pyogenes/isolation & purification , Epitopes/analysis , Primary Health Care/methods , Streptococcal Infections/diagnosisABSTRACT
INTRODUCTION: Streptococcus pyogenes is the most frequent bacterial cause of acute tonsillopharyngitis. The validity of the rapid antigen test was analysed for its diagnosis in a Paediatric Primary Care setting. The clinical profile with better diagnostic yield was also identified. The unnecessary use of antibiotics was quantified when the rapid antigen test or only the clinical diagnosis was used. The sensitivity of the assay to penicillin, erythromycin and clindamycin was also determined. PATIENTS AND METHODS: Cross-sectional study was conducted on children between 2 to 14 years with acute tonsillitis and/or pharyngitis seen in five Primary Care Centres, from January 2008 to May 2010. After a clinical diagnosis, two swabs were taken for pharyngotonsillar smears: the first was used for a rapid antigen test, and the second one for a culture and a study of antibiotic sensitivity, with its analysis being blind to the rapid test result. A total sample of 546 consecutive was envisaged and with consecutive sampling. RESULTS: A total 192 patients were included. The prevalence of Streptococcus pyogenes was 38.7% (95% CI: 31.4-45.7). Odynophagia and scarlatiniform rash were most likely with positive cultures, the Streptococcus pyogenes was sensitive to penicillin in 100%, to erythromycin in 97.3% and to clindamycin in 86.3%. The specificity of the rapid antigen test was 91.5% and with a Negative Predictive Value of 91.5%. About half (49.2%) of those who would have receive antibiotics for clinical suspicion would have been treated unnecessarily, with this decreasing to at least in 29.5% when using the rapid antigen test. CONCLUSIONS: The rapid antigen test can lead to a better use of antibiotics. Its use in Paediatric Primary Health Care could be useful when, as when the result is negative, there would be no need to confirm by a culture, in those Health Centres with difficult access to laboratory.
Subject(s)
Antigens, Bacterial/analysis , Pharyngitis/diagnosis , Pharyngitis/microbiology , Streptococcal Infections/diagnosis , Streptococcus pyogenes/immunology , Tonsillitis/diagnosis , Tonsillitis/microbiology , Adolescent , Child , Child, Preschool , Cross-Sectional Studies , Female , Humans , Male , Time FactorsABSTRACT
OBJECTIVE: To evaluate diagnostic concordance in the interpretation of electrocardiograms (ECG) between general practitioners and a referral cardiologist. DESIGN: Crossover and descriptive. SETTING: Seven General Medicine consulting rooms at Burgo de Osma Health Centre. PATIENTS AND OTHER PARTICIPANTS: 318 ECGs included and distributed at random among the doctors, from May 1992 to April 1993 (11 months). 28 were excluded for analysis. MEASUREMENTS AND MAIN RESULTS: The proportion of agreement observed (Po) and the Kappa (K) index were obtained. Po was > 90% in all diagnostic categories, except normality (76.5%). Overall K was 0.52 (C.I. 95%: 0.50-0.54); K = 0.79 in disturbances in frequency; K = 0.52 in diagnosis of normality; K = 0.46 in disturbances of rhythm; K = 0.38 in ventricular conduction disorders; K = 0.36 in repolarisation disturbances; K = 0.32 for disorders of the auricular-ventricular union; K = 0.17 for unspecific disorders and K = 0.07 for auricular disturbances. CONCLUSIONS: Overall concordance is acceptable, as it is for normality and rhythm and frequency disturbances; for the remaining diagnostic categories it was light or ordinary. The Primary Care team (PCT) in comparison with the cardiologist underdiagnosed the frequency and a-v union disorders and overdiagnosed the unspecific disorders. The PCT must improve in their diagnoses of greater prevalence and low K value.
Subject(s)
Arrhythmias, Cardiac/diagnosis , Electrocardiography , Cardiology , Cross-Over Studies , Data Interpretation, Statistical , Diagnosis, Differential , Family Practice , Humans , Random Allocation , Referral and ConsultationABSTRACT
OBJECTIVE: To find the characteristics of paediatric referrals to the referral hospital. DESIGN: An epidemiological study of a crossover type. SETTING: Two paediatric clinics at an urban Health Centre. PATIENTS AND OTHER PARTICIPANTS: A consecutive sample of 384 referrals during 1992. MEASUREMENTS AND MAIN RESULTS: 3.94% of patients were referred. Nursing babies were the most commonly referred group. The commonest diagnostic groups were: congenital anomalies (25.5%), Neurology and sense organs (24%) and Respiratory Pathology (15.9%). The clinics to which patients were most commonly referred were: Traumatology (25.5%), Ophthalmology (21.4%) and ENT (21.4%). 80.6% of the Traumatology referrals were for congenital anomalies. 72.9% were referred for confirmation of the diagnosis. 56.8% came from on-demand consultations and 43.2% from appointments. 84.6% were of a normal character. In 27.3% there was a written report from the specialist. CONCLUSIONS: Congenital anomalies made by the most frequently referred diagnostic group; and Traumatology the most consulted specialty. There was a low instance of referral at the patient's own request. There was a high number of patients referred from among patients with appointments. There was scant information from the specialist to the Paediatrician.
Subject(s)
Child Health Services , Referral and Consultation , Urban Health , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , SpainABSTRACT
OBJECTIVE: To assess the scheduled Paediatrics programme through the health problems cared for and the characteristics of care, evolution and follow-up. DESIGN: Descriptive study of a crossover type. SETTING: Two Paediatrics clinics in the "Soria Norte" Health Centre. PATIENTS: A non-probabilistic consecutive sample of 143 children under 10 during 1992. MAIN RESULTS: Average age was 3.69 +/- 2.97 years old. The commonest diagnostic groups were: Groups XVI (26.9%), III (18%), IX (9.6%), V and X (both 8.4%). 83% of the children were not following a procedure, 23% were being monitored by a specialist at the same time and 8% were referred. 36% of those with problems were following a treatment and 51% evolved for the better. CONCLUSIONS: The commonest problems are those which are badly defined and endocrine-metabolic ones. The problems where procedures were observed and the patients who followed through some treatment both made up low percentages. It is therefore important both to watch out for problems and to follow procedures more strictly.
