Twice-Daily Dosing of Dolutegravir in Infants on Rifampicin Treatment: A Pharmacokinetic Substudy of the EMPIRICAL Trial.

BACKGROUND: We evaluated dolutegravir pharmacokinetics in infants with human immunodeficiency virus (HIV) receiving dolutegravir twice daily (BID) with rifampicin-based tuberculosis (TB) treatment compared with once daily (OD) without rifampicin. METHODS: Infants with HIV aged 1-12 months, weighing ≥3 kg, and receiving dolutegravir BID with rifampicin or OD without rifampicin were eligible. Six blood samples were taken over 12 (BID) or 24 hours (OD). Dolutegravir pharmacokinetic parameters, HIV viral load (VL) data, and adverse events (AEs) were reported. RESULTS: Twenty-seven of 30 enrolled infants had evaluable pharmacokinetic curves. The median (interquartile range) age was 7.1 months (6.1-9.9), weight was 6.3 kg (5.6-7.2), 21 (78%) received rifampicin, and 11 (41%) were female. Geometric mean ratios comparing dolutegravir BID with rifampicin versus OD without rifampicin were area under curve (AUC)0-24h 0.91 (95% confidence interval, .59-1.42), Ctrough 0.95 (0.57-1.59), Cmax 0.87 (0.57-1.33). One infant (5%) receiving rifampicin versus none without rifampicin had dolutegravir Ctrough <0.32 mg/L, and none had Ctrough <0.064 mg/L. The dolutegravir metabolic ratio (dolutegravir-glucuronide AUC/dolutegravir AUC) was 2.3-fold higher in combination with rifampicin versus without rifampicin. Five of 82 reported AEs were possibly related to rifampicin or dolutegravir and resolved without treatment discontinuation. Upon TB treatment completion, HIV viral load was <1000 copies/mL in 76% and 100% of infants and undetectable in 35% and 20% of infants with and without rifampicin, respectively. CONCLUSIONS: Dolutegravir BID in infants receiving rifampicin resulted in adequate dolutegravir exposure, supporting this treatment approach for infants with HIV-TB coinfection.

First-Line Antituberculosis Drug Concentrations in Infants With HIV and a History of Recent Admission With Severe Pneumonia.

Optimal antituberculosis therapy is essential for favorable clinical outcomes. Peak plasma concentrations of first-line antituberculosis drugs in infants with living HIV receiving WHO-recommended dosing were low compared with reference values for adults, supporting studies on increased doses of first-line TB drugs in infants.

Testing the performance, adequacy, and applicability of an artificial intelligence model for pediatric pneumonia diagnosis.

BACKGROUND: Community-acquired Pneumonia (CAP) is a common childhood infectious disease. Deep learning models show promise in X-ray interpretation and diagnosis, but their validation should be extended due to limitations in the current validation workflow. To extend the standard validation workflow we propose doing a pilot test with the next characteristics. First, the assumption of perfect ground truth (100% sensitive and specific) is unrealistic, as high intra and inter-observer variability have been reported. To address this, we propose using Bayesian latent class models (BLCA) to estimate accuracy during the pilot. Additionally, assessing only the performance of a model without considering its applicability and acceptance by physicians is insufficient if we hope to integrate AI systems into day-to-day clinical practice. Therefore, we propose employing explainable artificial intelligence (XAI) methods during the pilot test to involve physicians and evaluate how well a Deep Learning model is accepted and how helpful it is for routine decisions as well as analyze its limitations by assessing the etiology. This study aims to apply the proposed pilot to test a deep Convolutional Neural Network (CNN)-based model for identifying consolidation in pediatric chest-X-ray (CXR) images already validated using the standard workflow. METHODS: For the standard validation workflow, a total of 5856 public CXRs and 950 private CXRs were used to train and validate the performance of the CNN model. The performance of the model was estimated assuming a perfect ground truth. For the pilot test proposed in this article, a total of 190 pediatric chest-X-ray (CXRs) images were used to test the CNN model support decision tool (SDT). The performance of the model on the pilot test was estimated using extensions of the two-test Bayesian Latent-Class model (BLCA). The sensitivity, specificity, and accuracy of the model were also assessed. The clinical characteristics of the patients were compared according to the model performance. The adequacy and applicability of the SDT was tested using XAI techniques. The adequacy of the SDT was assessed by asking two senior physicians the agreement rate with the SDT. The applicability was tested by asking three medical residents before and after using the SDT and the agreement between experts was calculated using the kappa index. RESULTS: The CRXs of the pilot test were labeled by the panel of experts into consolidation (124/176, 70.4%) and no-consolidation/other infiltrates (52/176, 29.5%). A total of 31/176 (17.6%) discrepancies were found between the model and the panel of experts with a kappa index of 0.6. The sensitivity and specificity reached a median of 90.9 (95% Credible Interval (CrI), 81.2-99.9) and 77.7 (95% CrI, 63.3-98.1), respectively. The senior physicians reported a high agreement rate (70%) with the system in identifying logical consolidation patterns. The three medical residents reached a higher agreement using SDT than alone with experts (0.66±0.1 vs. 0.75±0.2). CONCLUSIONS: Through the pilot test, we have successfully verified that the deep learning model was underestimated when a perfect ground truth was considered. Furthermore, by conducting adequacy and applicability tests, we can ensure that the model is able to identify logical patterns within the CXRs and that augmenting clinicians with automated preliminary read assistants could accelerate their workflows and enhance accuracy in identifying consolidation in pediatric CXR images.

Brief Report: Suboptimal Lopinavir Exposure in Infants on Rifampicin Treatment Receiving Double-dosed or Semisuperboosted Lopinavir/Ritonavir: Time for a Change.

BACKGROUND: Although super-boosted lopinavir/ritonavir (LPV/r; ratio 4:4 instead of 4:1) is recommended for infants living with HIV and receiving concomitant rifampicin, in clinical practice, many different LPV/r dosing strategies are applied due to poor availability of pediatric separate ritonavir formulations needed to superboost. We evaluated LPV pharmacokinetics in infants with HIV receiving LPV/r dosed according to local guidelines in various sub-Saharan African countries with or without rifampicin-based tuberculosis (TB) treatment. METHODS: This was a 2-arm pharmacokinetic substudy nested within the EMPIRICAL trial (#NCT03915366). Infants aged 1-12 months recruited into the main study were administered LPV/r according to local guidelines and drug availability either with or without rifampicin-based TB treatment; during rifampicin cotreatment, they received double-dosed (ratio 8:2) or semisuperboosted LPV/r (adding a ritonavir 100 mg crushed tablet to the evening LPV/r dose). Six blood samples were taken over 12 hours after intake of LPV/r. RESULTS: In total, 14/16 included infants had evaluable pharmacokinetic curves; 9/14 had rifampicin cotreatment (5 received double-dosed and 4 semisuperboosted LPV/r). The median (IQR) age was 6.4 months (5.4-9.8), weight 6.0 kg (5.2-6.8), and 10/14 were male. Of those receiving rifampicin, 6/9 infants (67%) had LPV Ctrough <1.0 mg/L compared with 1/5 (20%) in the control arm. LPV apparent oral clearance was 3.3-fold higher for infants receiving rifampicin. CONCLUSION: Double-dosed or semisuperboosted LPV/r for infants aged 1-12 months receiving rifampicin resulted in substantial proportions of subtherapeutic LPV levels. There is an urgent need for data on alternative antiretroviral regimens in infants with HIV/TB coinfection, including twice-daily dolutegravir.

Intervenciones para la exploración del pie en pacientes diabéticos, en Atención Primaria: Una revisión sistemática de Guías de Práctica Clínica / Interventions for foot examination in diabetic patients in primary care: a review of clinical practice guidelines

Objetivo principal: Identificar la mejor evidencia disponible sobre inter venciones efectivas para la exploración y estratificación del PD. Metodología: Revisión de Guías de Práctica Clínica con recomendacio nes acerca de la exploración y estratifi cación del PD. Resultados principales: Recopi lamos las intervenciones que son más efectivas para diagnosticar precozmente el PD en A.P recogidas de 10 GPC. In cluyen la evaluación visual de los pies, la valoración de la neuropatía diabética pe riférica mediante monofilamento de Semmes-Weinstein de 10 g, diapasón de 128 Hz y exploración del reflejo aquíleo, y la valoración de la enfermedad arterial periférica mediante la palpación de pul sos periféricos y determinación del índice tobillo brazo. Posteriormente estratifica ción del riesgo de desarrollar un PD. Conclusión principal: La monitori zación de las extremidades inferiores debe formar parte de los planes de cui dados de los pacientes diabéticos. Se deberían establecer unidades especiali zadas en atención al PD y poder derivar desde AP a estos pacientes (AU)

Interventions for foot examination in diabetic patients in Primary Care: A review of Clinical Practice Guidelines Main objective: To identify the best available evidence on effective in terventions in the exploration and diag nosis of DF. Methodology: Review of the Clini cal Practice Guidelines with recommen dations on the exploration and stratifica tion of DF. Main results: We compiled the interventions that are most effective for early diagnosis of DF in P.C collected in 10 CPG. They include visual assessment of their feet, assessment of diabetic pe ripheral neuropathy using a 10-g Sem mes-Weinstein monofilament, 128-Hz tuning fork, and Achilles reflex testing, assessment of peripheral arterial disease by palpation of peripheral pulses, and determination of the ankle arm index Subsequently, risk stratification of deve loping DF. Main conclusion: Monitoring of the lower extremities should be part of the care plans for diabetic patients. Spe cialized units should be established for DF care and these patients should be able to be referred from PC (AU)

¿Qué intervenciones educativas son efectivas para prevenir el pie diabético? Una Revisión de Guías de Práctica Clínica / What educational interventions are effective in preventing diabetic foot? A review of clinical practice guidelines

Objetivo principal: Identificar la mejor evidencia disponible sobre inter venciones educativas que pueden ayu dar a prevenir la aparición del Pie Diabé tico (PD) en Atención Primaria (AP). Metodología: Revisión sistemáti ca de Guías de Práctica clínica (GPC) con recomendaciones acerca de inter venciones educativas para prevenir el PD. La búsqueda se ha llevado a cabo en bases de datos de fuentes terciarias, secundarias y primarias con los descrip tores Diabetes mellitus, Pie diabético y Educación en salud. Para evaluar la cali dad de las GPC encontradas se utilizó la herramienta AGREE II. Resultados: Fueron recopiladas las intervenciones educativas que, según las 10 GPC revisadas, pueden resultar más efectivas para prevenir la aparición del PD en AP. Estas recomendaciones, han sido incluidas como actividades de los NIC (Nursing Interventions Classifica tion) relacionados con el tema. Conclusión: El resultado principal de este trabajo indica que las interven ciones educativas para prevenir la apari ción del PD deben formar parte, de ma nera inexcusable, de los planes de cui dados en los pacientes diabéticos. Son unas intervenciones que parecen ser muy costo efectivas y que, estructuradas adecuadamente, pueden contribuir a disminuir la incidencia de PD y a reducir el número de amputaciones (AU)

Main objective: Identify the best available evidence on educational inter ventions that can help prevent the ap pearance of Diabetic Foot (DF) in Pri mary Care. Methodology: Systematic review on 10 Clinical Practice Guidelines (CPG) with recommendations on education to prevent the DF. The search was carried out in databases of tertiary, secondary and primary sources with the descriptors Diabetes mellitus, Diabetic foot and Health education. The AGREE II tool was used to assess the quality of the CPGs found. Results: Were compiled the edu cational interventions that, according to the revised 10 CPG’s, are more effective in preventing the appearance of DF in Primary Care. Have been included these recommendations as NIC (Nursing Inter ventions Classification) activities related to the topic. Conclusion: The main result of this work indicates that educational inter ventions to prevent the onset of DF mus inexcusably form part of the care plans for diabetic patients. These are interven tions that appear to be very cost-effecti ve, properly structured, will help reduce the incidence of DF and reduce the num ber of amputations (AU)

Oral saliva swab reverse transcription PCR for Covid-19 in the paediatric population.

OBJECTIVES: To evaluate the performance of oral saliva swab (OSS) reverse transcription PCR (RT-PCR) compared with RT-PCR and antigen rapid diagnostic test (Ag-RDT) on nasopharyngeal swabs (NPS) for SARS-CoV-2 in children. DESIGN: Cross-sectional multicentre diagnostic study. SETTING: Study nested in a prospective, observational cohort (EPICO-AEP) performed between February and March 2021 including 10 hospitals in Spain. PATIENTS: Children from 0 to 18 years with symptoms compatible with Covid-19 of ≤5 days of duration were included. Two NPS samples (Ag-RDT and RT-PCR) and one OSS sample for RT-PCR were collected. MAIN OUTCOME: Performance of Ag-RDT and RT-PCR on NPS and RT-PCR on OSS sample for SARS-CoV-2. RESULTS: 1174 children were included, aged 3.8 years (IQR 1.7-9.0); 73/1174 (6.2%) patients tested positive by at least one of the techniques. Sensitivity and specificity of OSS RT-PCR were 72.1% (95% CI 59.7 to 81.9) and 99.6% (95% CI 99 to 99.9), respectively, versus 61.8% (95% CI 49.1 to 73) and 99.9% (95% CI 99.4 to 100) for the Ag-RDT. Kappa index was 0.79 (95% CI 0.72 to 0.88) for OSS RT-PCR and 0.74 (95% CI 0.65 to 0.84) for Ag-RDT versus NPS RT-PCR. CONCLUSIONS: RT-PCR on the OSS sample is an accurate option for SARS-CoV-2 testing in children. A less intrusive technique for younger patients, who usually are tested frequently, might increase the number of patients tested.

Comparison of pneumonia features in children caused by SARS-CoV-2 and other viral respiratory pathogens.

BACKGROUND: Pneumonia is a frequent manifestation of coronavirus disease 2019 (COVID-19) in hospitalized children. METHODS: The study involved 80 hospitals in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Spanish Pediatric National Cohort. Participants were children <18 years, hospitalized with SARS-CoV-2 community-acquired pneumonia (CAP). We compared the clinical and radiological characteristics of SARS-CoV-2-associated CAP with CAP due to other viral etiologies from ValsDance (retrospective) cohort. RESULTS: In total, 151 children with SARS-CoV-2-associated CAP and 138 with other viral CAP were included. Main clinical features of SARS-CoV-2-associated CAP were cough, fever, or dyspnea. Lymphopenia was found in 43% patients and 15% required admission to the pediatric intensive care unit (PICU). Chest X-ray revealed condensation (42%) and other infiltrates (58%). Compared with CAP from other viral pathogens, COVID-19 patients were older, with lower C-reactive protein (CRP) levels, less wheezing, and greater need of mechanical ventilation (MV). There were no differences in the use of continuous positive airway pressure (CPAP) or HVF, or PICU admission between groups. CONCLUSION: SARS-CoV-2-associated CAP in children presents differently to other virus-associated CAP: children are older and rarely have wheezing or high CRP levels; they need less oxygen but more CPAP or MV. However, several features overlap and differentiating the etiology may be difficult. The overall prognosis is good.

COVCOG 1: Factors Predicting Physical, Neurological and Cognitive Symptoms in Long COVID in a Community Sample. A First Publication From the COVID and Cognition Study.

Since its first emergence in December 2019, coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has evolved into a global pandemic. Whilst often considered a respiratory disease, a large proportion of COVID-19 patients report neurological symptoms, and there is accumulating evidence for neural damage in some individuals, with recent studies suggesting loss of gray matter in multiple regions, particularly in the left hemisphere. There are a number of mechanisms by which COVID-19 infection may lead to neurological symptoms and structural and functional changes in the brain, and it is reasonable to expect that many of these may translate into cognitive problems. Indeed, cognitive problems are one of the most commonly reported symptoms in those experiencing "Long COVID"-the chronic illness following COVID-19 infection that affects between 10 and 25% of patients. The COVID and Cognition Study is a part cross-sectional, part longitudinal, study documenting and aiming to understand the cognitive problems in Long COVID. In this first paper from the study, we document the characteristics of our sample of 181 individuals who had experienced COVID-19 infection, and 185 who had not. We explore which factors may be predictive of ongoing symptoms and their severity, as well as conducting an in-depth analysis of symptom profiles. Finally, we explore which factors predict the presence and severity of cognitive symptoms, both throughout the ongoing illness and at the time of testing. The main finding from this first analysis is that that severity of initial illness is a significant predictor of the presence and severity of ongoing symptoms, and that some symptoms during the initial illness-particularly limb weakness-may be more common in those that have more severe ongoing symptoms. Symptom profiles can be well described in terms of 5 or 6 factors, reflecting the variety of this highly heterogenous condition experienced by the individual. Specifically, we found that neurological/psychiatric and fatigue/mixed symptoms during the initial illness, and that neurological, gastrointestinal, and cardiopulmonary/fatigue symptoms during the ongoing illness, predicted experience of cognitive symptoms.

COVCOG 2: Cognitive and Memory Deficits in Long COVID: A Second Publication From the COVID and Cognition Study.

COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been often characterized as a respiratory disease. However, it is increasingly being understood as an infection that impacts multiple systems, and many patients report neurological symptoms. Indeed, there is accumulating evidence for neural damage in some individuals, with recent studies suggesting loss of gray matter in multiple regions, particularly in the left hemisphere. There are several mechanisms by which the COVID-19 infection may lead to neurological symptoms and structural and functional changes in the brain, and cognitive problems are one of the most commonly reported symptoms in those experiencing Long COVID - the chronic illness following the COVID-19 infection that affects between 10 and 25% of patients. However, there is yet little research testing cognition in Long COVID. The COVID and Cognition Study is a cross-sectional/longitudinal study aiming to understand cognitive problems in Long COVID. The first paper from the study explored the characteristics of our sample of 181 individuals who had experienced the COVID-19 infection, and 185 who had not, and the factors that predicted ongoing symptoms and self-reported cognitive deficits. In this second paper from the study, we assess this sample on tests of memory, language, and executive function. We hypothesize that performance on "objective" cognitive tests will reflect self-reported cognitive symptoms. We further hypothesize that some symptom profiles may be more predictive of cognitive performance than others, perhaps giving some information about the mechanism. We found a consistent pattern of memory deficits in those that had experienced the COVID-19 infection, with deficits increasing with the severity of self-reported ongoing symptoms. Fatigue/Mixed symptoms during the initial illness and ongoing neurological symptoms were predictive of cognitive performance.

Antibiotic Prescribing in Children Hospitalized With COVID-19 and Multisystem Inflammatory Syndrome in Spain: Prevalence, Trends, and Associated Factors.

The SARS-CoV-2 pandemic has caused an increase in antibiotic use in different settings. We describe the antibiotic prescribing prevalence, associated factors and trends, as well as concomitant bacterial infections in children hospitalized with COVID-19 or multisystemic inflammatory syndrome related to SARS-CoV-2 in Spain.

Clinical spectrum of COVID-19 and risk factors associated with severity in Spanish children.

We aimed to identify the spectrum of disease in children with COVID-19, and the risk factors for admission in paediatric intensive care units (PICUs). We conducted a multicentre, prospective study of children with SARS-CoV-2 infection in 76 Spanish hospitals. We included children with COVID-19 or multi-inflammatory syndrome (MIS-C) younger than 18 years old, attended during the first year of the pandemic. We enrolled 1200 children. A total of 666 (55.5%) were hospitalised, and 123 (18.4%) required admission to PICU. Most frequent major clinical syndromes in the cohort were mild syndrome (including upper respiratory tract infection and flu-like syndrome, skin or mucosae problems and asymptomatic), 44.8%; bronchopulmonary syndrome (including pneumonia, bronchitis and asthma flare), 18.5%; fever without a source, 16.2%; MIS-C, 10.6%; and gastrointestinal syndrome, 10%. In hospitalised children, the proportions were 28.5%, 25.7%, 16.5%, 19.1% and 10.2%, respectively. Risk factors associated with PICU admission were age in months (OR: 1.007; 95% CI 1.004 to 1.01), MIS-C (OR: 14.4, 95% CI 8.9 to 23.8), chronic cardiac disease (OR: 4.8, 95% CI 1.8 to 13), asthma or recurrent wheezing (OR: 2.5, 95% CI 1.2 to 5.2) and after excluding MIS-C patients, moderate/severe liver disease (OR: 8.6, 95% CI 1.6 to 47.6). However, asthmatic children were admitted into the PICU due to MIS-C or pneumonia, not due to asthma flare.Conclusion: Hospitalised children with COVID-19 usually present as one of five major clinical phenotypes of decreasing severity. Risk factors for PICU include MIS-C, elevation of inflammation biomarkers, asthma, moderate or severe liver disease and cardiac disease. What is Known: • All studies suggest that children are less susceptible to serious SARS-CoV-2 infection when compared to adults. Most studies describe symptoms at presentation. However, it remains unclear how these symptoms group together into clinically identifiable syndromes and the severity associated with them. What is New: • We have gathered the primary diagnoses into five major syndromes of decreasing severity: MIS-C, bronchopulmonary syndrome, gastrointestinal syndrome, fever without a source and mild syndrome. Classification of the children in one of the syndromes is unique and helps to assess the risk of critical illness and to define the spectrum of the disease instead of just describing symptoms and signs.

Dynamics of Reverse Transcription-Polymerase Chain Reaction and Serologic Test Results in Children with SARS-CoV-2 Infection.

OBJECTIVES: To determine the time to reverse transcription-polymerase chain reaction (RT-PCR) negativity after the first positive RT-PCR test, factors associated with longer time to RT-PCR negativity, proportion of children seroconverting after proven severe acute respiratory syndrome coronavirus 2 infection, and factors associated with the lack of seroconversion. STUDY DESIGN: The Epidemiological Study of Coronavirus in Children of the Spanish Society of Pediatrics is a multicenter study conducted in Spanish children to assess the characteristics of coronavirus disease 2019. In a subset of patients, 3 serial RT-PCR tests on nasopharyngeal swab specimens were performed after the first RT-PCR test, and immunoglobulin G serology for severe acute respiratory syndrome coronavirus 2 antibodies was performed in the acute and follow-up (<14 and ≥14 days after diagnosis) phase. RESULTS: In total, 324 patients were included in the study. The median time to RT-PCR negativity was 17 days (IQR, 8-29 days), and 35% of patients remained positive more than 4 weeks after the first RT-PCR test. The probability of RT-PCR negativity did not differ across groups defined by sex, disease severity, immunosuppressive drugs, or clinical phenotype. Globally, 24% of children failed to seroconvert after infection. Seroconversion was associated with hospitalization, persistence of RT-PCR positivity, and days of fever. CONCLUSIONS: Time to RT-PCR negativity was long, regardless of the severity of symptoms or other patient features. This finding should be considered when interpreting RT-PCR results in a child with symptoms, especially those with mild symptoms. Seroprevalence and postimmunization studies should consider that 11 in 4 infected children fail to seroconvert.

“TU SELLO” 430 Aniversario de la Orden de San Juan de Dios en Palencia / “TU SELLO” 430th Anniversary of the Order of San Juan de Dios in Palencia

Introducción: San Juan de Dios nace en Portugal en 1495. En el Real Monasterio de Santa María de Guadalupe, en Cáceres, se forma en el cuidado de los enfermos. Regresa a Granada y comienza a dedicarse al cuidado de los pobres sin hogar y los enfermos, instituyendo un hospital para tales fines. Muere el 8 de marzo de 1550. El primer sello postal que conmemora a San Juan de Dios es emitido en Portugal en 1949 con ocasión del IV Centenario de su muerte. Metodología: Para llevar a cabo el análisis del “TU SELLO”, se ha utilizado el método iconográfico-iconológico de Panofsky. Resultados: Se presenta el “TU SELLO” emitido en conmemoración del “430 Aniversario de la Orden de San Juan de Dios en Palencia”. El diseño se basa en el grupo escultórico creado por Óscar Aragón, que se inauguró el 4 de diciembre de 2017, con motivo del 425 aniversario de la presencia de la Orden en Palencia. En el sello aparece un arco que simboliza la puerta del hospital de San Juan de Dios de Palencia y, por otro lado, dos figuras que representan a San Juan de Dios abrazando y ayudando, en un gesto de protección, a otra figura que es una representación alegórica de la enfermedad. Discusión: La utilización de los sellos personalizados es una manera de dar a conocer, a través de la filatelia, acontecimientos, personajes, hechos relevantes o efemérides que de otra manera no tendrían su reflejo en el sello postal, dada la limitada y exigente política de los servicios filatélicos de los distintos países para incluir en sus emisiones todo lo que de relevante puede ocurrir a lo largo de un año. Este ha sido, y no otro, el objetivo de emitir este “TU SELLO” homenaje al 430 Aniversario de la Orden de San Juan de Dios en Palencia (AU)

Introduction: St. Juan de Dios was born in Portugal in 1495. In the Royal Monastery of Santa María de Guadalupe, in Cáceres, he was trained in the care of the sick. He returns to Granada and begins to dedicate himself to the care of the poor homeless and the sick, establishing a hospital for such purposes. He died on March 8, 1550. The first postage stamp commemorating St. Juan de Dios was issued in Portugal in 1949 on the IV Centenary of his death. Methodology: To carry out the analysis of " TU SELLO ", the iconographic-iconological method of Panofsky has been used. Results: The "TU SELLO" issued in commemoration of the "430th Anniversary of the Order of St. Juan de Dios in Palencia" is presented. The design is based on the sculptural group created by Óscar Aragón, which was inaugurated on December 4, 2017, on the 425th anniversary of the presence of the Order in Palencia. In the stamp appears an arch that symbolizes the door of the hospital of St. Juan de Dios in Palencia and, on the other side, two figures that represent St. Juan de Dios, embracing and helping, in a gesture of protection, another figure that is an allegorical representation of the disease. Discussion: The use of personalized stamps is a way of making known, through philately, events, characters, relevant facts, or ephemeris that otherwise would not be reflected in the postage stamp, given the limited and demanding policy of philatelist services from different countries to include in their issues every relevant event that may occur over the course of a year. This has been, and no other, the objective of issuing this "TU SELLO" tribute to the 430th Anniversary of the Order of St. Juan de Dios in Palencia (AU)

APORTE DE HOJARASCA DEL MANGLE NEGRO (Avicennia germinans L. ) EN EL CARIBE COLOMBIANO / CONTRIBUTION OF BLACK MANGROVE (Avicennia germinans L. ) FALLEN LEAVES IN THE COLOMBIAN CARIBBEAN AREA

A pesar que los manglares son reconocidos a nivel mundial como ecosistemas altamente productivos y ecológicamente importantes, en la actualidad, su extensión se ha reducido significativamente debido a las actividades humanas en las zonas costeras. Por lo tanto, es necesario investigar su dinámica y respuestas bajo el creciente y sostenido impacto del cambio climático y antropogénico. Durante dos estaciones climáticas contrastantes (sequía, lluvia) se estudió la producción de hojarasca del mangle negro Avicennia germinans L. en la bahía El Uno cerca al municipio de Turbo, noroccidente de Colombia (8º N). El aporte de materia orgánica fue separado por estructuras (hojas, ramas, flores y frutos) donde se registró un aporte significativamente mayor de hojas. La biomasa seca total durante ambas estaciones fue de 7,09±9,66 y 5,36±5,67 g m-2día-1. Los valores mínimos y máximos fueron de 0,63-8 y 0,49-3,65 g m-2día-1 durante la estación seca y lluviosa, respectivamente. Se detectaron diferencias significativas entre las estructuras orgánicas pero no entre las estaciones climáticas analizadas. Se discuten algunos impactos naturales y antropogénicos pasados y actuales, que afectan la dinámica de los manglares, al igual que la importancia de la producción de hojarasca para la productividad primaria y secundaria, en zonas altamente perturbadas del Caribe colombiano.

Although mangroves are recognized worldwide as highly productive and ecologically important ecosystems , at present its extent has been significantly reduced due to human activities in coastal areas. Therefore, it is necessary to investigate their dynamics and responses under the growing and sustained climatic and anthropogenic impacts. During two contrasting seasons (drought, rain) the fallen leaves production of the black mangrove Avicennia germinans L. was investigated at El Uno Bay, near Turbo Municipality, North-Western Colombia (8º N). Organic matter input was sorted by structure (leaves, branches, flowers, fruits) with leaves registering the highest significant values. Total dry biomass during both seasons was 7.09±9.66 and 5.36±5.67 g m-2day-1. The lowest and highest organic matter values were 0.63-8 and 0.49-3.65 g m-2day-1 during the dry and rainy season, respectively. Significant differences between organic structures but not between seasons analyzed were detected. Some relevant past and present natural and anthropogenic impacts affecting the mangroves dynamics are discussed, as well as the importance of fallen leaves input to the primary and secondary production in highly disturbed zones of the Colombian Caribbean area.

Actuación enfermera en el manejo de la infección de las heridas / Nursing performance in the management of wound infection

Objetivo: conocer el manejo por parte de las enfermeras/os del Área de Salud de Palencia, de los apósitos de plata en las heridas infectadas.Material y método: estudio descriptivo transversal. La población objeto de estudio estaba formada por todos los profesionales de Enfermería que ejercían función asistencial en las distintas instituciones públicas y privadas de Palencia. La recogida de datos fue mediante un cuestionario de ocho ítems de respuesta cerrada yuna pregunta abierta. Resultados: ante un paciente con una herida infectada, el 60% realizaban derivación médica para pautar tratamiento antibiótico y el 23% (n=31) realizaban cura con antibiótico local. El 60% manifestóno conocer los apósitos de plata y entre los que los usaban, el 77% los calificó como buenos productos.Conclusiones: de los datos se desprende la enorme confusión existente a la hora de manejar cura seca y húmeda, profilaxis, antisépticos y antibióticos, así como la falta de criterios y autonomía a la hora de pautar los cuidados enfermeros de estas lesiones

Objective: to determine the nursing management of silver dressings for infected wounds in a healthcare area of Palencia. Material and method: cross-sectional descriptive study. The study population was composed by all the nursing professionals that practiced nursing in the different public and private institutions in Palencia. Data collection was carried out by means of an 8 item closed questions and one open question item questionnaire. Results: when faced with a patient with an infected wound, 60% of the nurses referred the patient to a doctor for prescription of antibiotics and 23% (n=31) cleaned the wound with a local antibiotic. 60% manifested not to know about silver dressings and 77% of those who did use this material, classified it as a very good product. Conclusions: the data show the enormous confusion there is regarding the management of moist vs dry clean wound care, prophylaxis, antiseptics and antibiotics, as well as the lack of criteria toestablish appropriate nursing care for these lesions

[Three cases of Yersinia pseudotuberculosis gastrointestinal infection having no apparent epidemiological relationship, caused by identical strains]. / Tres casos de infección gastrointestinal sin aparente relación epidemiológica producidos por la misma cepa de Yersinia pseudotuberculosis.

INTRODUCTION: Gastrointestinal infections caused by Yersinia pseudotuberculosis are uncommon in our country and the epidemiology of the infection is uncertain. METHODS: We describe three cases of Y. pseudotuberculosis gastrointestinal infection, all detected within one month of time. A possible epidemiological relationship among these cases, as well as the microbial characteristics of the isolates, was investigated. RESULTS. No epidemiological relationships were found among the three cases. Nevertheless, all three isolates were identical according to phenotyping and molecular marker studies. CONCLUSION: This report discusses the possible source of infection in these cases, with reference to published data from sporadic cases and outbreaks of infection by this microorganism. We suggest that future studies are needed to know the real incidence of Y. pseudotuberculosis in our country.

Tres casos de infección gastrointestinal sin aparente relación epidemiológica producidos por la misma cepa de Yersinia pseudotuberculosis / Three cases of Yersinia pseudotuberculosis gastrointestinal infection having no apparent epidemiological relationship, caused by identical strains

INTRODUCCIÓN. La infección gastrointestinal producida por Yersinia pseudotuberculosis es poco frecuente en nuestro medio. Además la epidemiología de la infección es poco conocida. MÉTODOS. Se presentan 3 casos de infección gastrointestinal producidas en el período de un mes por Y. pseudotuberculosis. Se investigó la posible relación epidemiológica de los mismos, así como las características microbiológicas de los aislados. RESULTADOS. Entre los 3 casos no se ha encontrado ninguna relación epidemiológica. Los 3 aislamientos fueron idénticos tras el estudio de marcadores fenotípicos y moleculares. CONCLUSIÓN. En este informe se discute la posible fuente de infección de los casos, atendiendo a los datos previamente descritos de casos esporádicos y brotes de infección producidos por este microorganismo. Se sugiere la posibilidad de profundizar en la investigación de la incidencia real de esta infección en nuestro medio (AU)

INTRODUCTION. Gastrointestinal infections caused by Yersinia pseudotuberculosis are uncommon in our country and the epidemiology of the infection is uncertain. METHODS. We describe three cases of Y. pseudotuberculosis gastrointestinal infection, all detected within one month of time. A possible epidemiological relationship among these cases, as well as the microbial characteristics of the isolates, was investigated. RESULTS. No epidemiological relationships were found among the three cases. Never the less, all three isolates were identical according to phenotyping and molecular marker studies. CONCLUSION. This report discusses the possible source of infection in these cases, with reference to published data from sporadic cases and outbreaks of infection by this microorganism. We suggest that future studies are needed to know the real incidence of Y. pseudotuberculosis in our country (AU)

Síndrome de Terson: Amaurosis reversible secundaria a la hemorragia subaracnoidea (Presentación de 4 casos) / Terson Syndrome: reversible amaurosis secondary to subarachnoideal hemorrage

La pérdida de visión, como consecuencia de una hemorragia a nivel del vítreo en el curso de una hemorragia subaracnoidea, es conocida como Síndrome de Terson. Si bien las hemorragias del vítreo son afecciones bien conocidas y descritas en la literatura oftalmológica como complicaciones de una hemorragia subaracnoidea, es una afección muy frecuente. La fisiopatología de esta complicación no es clara, habiendose planteado por diferentes autores varias teorías para explicar la aparición de la sangre a nivel del vítreo. Si bien su presencia se sospecha por la clínica, solamente la ecografía ocular confirma su existencia. En general, se plantea que tiene buen pronóstico a largo plazo, ya que la recuperación de la visión es la regla, sea espontáneamente o luego de la vitrectomía. Los autores presentan 4 casos de esta rara complicación