Actualización del documento de consenso sobre el diagnóstico y tratamiento de la faringoamigdalitis aguda / Diagnosis and treatment of acute tonsillopharyngitis. Consensus document update

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[Diagnosis and treatment of acute tonsillopharyngitis. Consensus document update]. / Actualización del documento de consenso sobre el diagnóstico y tratamiento de la faringoamigdalitis aguda.

An update of the Spanish consensus document on the diagnosis and treatment of acute tonsillopharyngitis is presented. Clinical scores should not be used to prescribe antibiotics, unless microbiological tests are not available or there is a child at risk of rheumatic fever. There is no score better than those set out in the previous consensus. Microbiological tests are recommended in proposed cases, regardless of the result of the scores. Penicillin is the treatment of choice, prescribed twice a day for 10 days. Amoxicillin is the first alternative, prescribed once or twice a day for the same time. First-generation cephalosporins are the treatment of choice in children with non-immediate reaction to penicillin or amoxicillin. Josamycin and midecamycin are the best options for children with immediate penicillin allergic reactions, when non-beta-lactam antibiotics should be used. In microbiological treatment failure, and in streptococcal carriers, the treatments proposed in the previous consensus are still applicable.

«Preparo Mi Rotación Por», complemento virtual de la formación MIR en Pediatría / «I Prepare My Rotation By», a virtual complement of paediatric specialist training

La Asociación Española de Pediatría (AEP) tiene entre sus objetivos desarrollar actividades encaminadas a la formación de sus socios. Así, en 2013 puso en marcha su proyecto formativo más ambicioso, la plataforma de formación virtual «Continuum». Se presenta ahora una nueva sección dirigida a los médicos internos residentes (MIR) en Pediatría y a sus tutores: «Preparo Mi Rotación Por» (PMRP), que tiene como propósitos disminuir la variabilidad en la formación de los MIR, asistir a los tutores en su función docente, facilitar el aprendizaje colaborativo y basado en competencias, el entrenamiento reflexivo y la resolución de problemas propios del perfil profesional de cada especialidad pediátrica. PMRP se distribuye en tres secciones principales: «De dónde partimos» (con las subsecciones: cuestionario de autoevaluación y contrato de aprendizaje), «Situaciones a resolver» (donde se desglosan los escenarios clínicos que han sido escogidos en el contrato de aprendizaje) y «A dónde llegamos» (que vuelve a incluir las subsecciones del comienzo de la rotación, para comprobar si los objetivos previstos han sido alcanzados, y el informe de evaluación). Además, cuenta con otros recursos: conocimientos previos, porfolio y foro de debate. Cabe destacar cinco aspectos del modelo formativo propuesto en esta nueva sección: el escenario clínico como punto de partida; el aprendizaje basado en competencias (fundamentado en el Global Pediatric Educational Consortium); la evaluación como estímulo de formación; el poder del aprendizaje colaborativo, y la participación de las diferentes sociedades de especialidad de la AEP en el desarrollo de sus contenidos

The Spanish Paediatric Association (AEP) has, among its objectives, to develop activities aimed at the training of its members. Thus, in 2013, it began its most ambitious training project, the virtual platform, «Continuum». Now it presents a new section aimed at Internal Medicine Residents (MIR) in Paediatrics and their tutors: «I Prepare My Rotation By» (PMRP), which has as objectives to reduce the variation in MIR training, to help the tutors in their teaching function, to facilitate collaborative and skill-based learning, reflective training, and the resolving of the particular problems of the professional profile of each paediatric speciality. PMRP is split into three main sections: «From where do we start» (with the sub-sections: self-assessment questionnaire and learning agreement), «Situations to resolve» (where the clinical scenarios that have been selected in the learning agreement are broken down), and «To where have we got» (which includes again the sub-sections at the beginning of the rotation in order to check if the expected objectives have been reached, and the assessment report). It also has other resources: prior knowledge, portfolio, and discussion forum. Five features of the proposed training model should be highlighted: the clinical scenario as a starting point; skill-based learning (based on the Global Paediatric Educational Consortium); the assessment as a training stimulus; the power of collaborative learning, and the participation of the different specialist societies of the AEP in the development of its contents

[«I Prepare My Rotation By¼, a virtual complement of paediatric specialist training]. / «Preparo Mi Rotación Por¼, complemento virtual de la formación MIR en Pediatría.

The Spanish Paediatric Association (AEP) has, among its objectives, to develop activities aimed at the training of its members. Thus, in 2013, it began its most ambitious training project, the virtual platform, «Continuum¼. Now it presents a new section aimed at Internal Medicine Residents (MIR) in Paediatrics and their tutors: «I Prepare My Rotation By¼ (PMRP), which has as objectives to reduce the variation in MIR training, to help the tutors in their teaching function, to facilitate collaborative and skill-based learning, reflective training, and the resolving of the particular problems of the professional profile of each paediatric speciality. PMRP is split into three main sections: «From where do we start¼ (with the sub-sections: self-assessment questionnaire and learning agreement), «Situations to resolve¼ (where the clinical scenarios that have been selected in the learning agreement are broken down), and «To where have we got¼ (which includes again the sub-sections at the beginning of the rotation in order to check if the expected objectives have been reached, and the assessment report). It also has other resources: prior knowledge, portfolio, and discussion forum. Five features of the proposed training model should be highlighted: the clinical scenario as a starting point; skill-based learning (based on the Global Paediatric Educational Consortium); the assessment as a training stimulus; the power of collaborative learning, and the participation of the different specialist societies of the AEP in the development of its contents.

Continuum: el poder del aprendizaje virtual y la Web 2.0 en la formación médica en Pediatría. Tres años de experiencia / Continuum: the power of e-learning and Web 2.0 in medical training in paediatrics. Three years of experience

Los médicos tienen el compromiso de mantener al día sus competencias y ser críticos en su ejercicio profesional. Internet ha supuesto una revolución en la distribución de información y conocimiento. Las sociedades científicas tienen la responsabilidad de responder a las necesidades de formación de quienes representan, diseñar estrategias para enlazar formación y práctica médica, y brindar una atención óptima a la población. Se presenta la experiencia de Continuum, plataforma de formación diseñada ad hoc por la Asociación Española de Pediatría, que partiendo del Curriculum Global de Educación Pediátrica (GPEC) promueve una formación basada en competencias, sitúa al alumno (pregrado, posgrado, profesionales en ejercicio) en el centro del proceso de enseñanza-aprendizaje y establece una relación directa entre las competencias requeridas (conocimientos, habilidades y actitudes) y los contenidos de formación. Entre las actividades formativas desarrolladas en Continuum, cabe citar: cursos de formación y actividades individuales agrupadas en distintas secciones (Imagen de la semana, Casos clínicos interactivos, Novedades bibliográficas, Artículo destacado, Píldoras formativas, Herramientas para la consulta). En este artículo exponemos las señas de identidad y las fortalezas de Continuum, el portal de formación en Pediatría de la Asociación Española de Pediatría, y la experiencia adquirida en los 3 años de andadura

Doctors are committed to maintain competence and be critical in their professional practice. The internet revolution has led to a new age of disseminating information and knowledge. The Scientific Societies are entrusted with the training needs of those that they represent, with the development of strategies to link training and medical practice. They also have a responsibility to provide optimal healthcare to the population. The experience of Continuum is presented in this article. It is a training platform based on the Global Curriculum for Paediatric Education (GPEC), designed ad hoc by the Spanish Paediatric Association. Continuum promotes a competency-based training, in which students (undergraduate, graduate, and practicing physicians) are the centre of the teaching-learning process. The Continuum approach establishes a direct relationship between the competences that are needed for a competent paediatric practice (knowledge, skills, and attitudes), as well as training material. Training activities in Continuum include: training courses and individual learning activities, distributed into different sections ("Weekly image", "interactive clinical cases", "News in bibliography", "Highlighted Article", "Pills" and "tools for daily practice"). In this article we present the hallmarks and strengths of Continuum, the training platform of the Spanish Paediatric Association, and the experience achieve during these first three years of its existence

Uso de la ecocardiografía en el diagnóstico y tratamiento de pacientes con mixomas cardíacos / Use of echocardiogram in the diagnosis and treatment of patients with cardiac myxomata

Se realizó un estudio descriptivo, retrospectivo, de corte transversal, de 51 pacientes con tumores cardíacos intracavitarios de la variedad histológica mixoma, quienes fueron asistidos y operados en el Servicio de Cardiología y Cirugía Cardiovascular del Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres de Santiago de Cuba, en el período de enero de 1987 a igual mes de 2016, con vistas a describir las principales características clínicas y ecocardiográficas presentes en ellos. En la serie predominaron las mujeres (64,7 por ciento) y las edades de 40-49 años (33,3 por ciento); en 86,3 por ciento de los pacientes el tumor se localizó en la aurícula izquierda, en 11,8 por ciento, en la aurícula derecha y 1,9 por ciento, en el ventrículo izquierdo. En todos los afectados la ecocardiografía (bidimensional y Doppler) resultó el método de diagnóstico determinante y la herramienta insustituible para la toma de decisiones del cardiólogo y del cirujano cardiovascular(AU)

A descriptive, retrospective, cross-sectional study, of 51 patients with intracavity cardiac tumors of the histologic variety myxoma who were assisted and operated in the Cardiology and Cardiovascular Surgery Service of Saturnino Lora Torres Teaching Clinical Surgical Provincial Hospital in Santiago de Cuba, was carried out from January, 1987 to the same month in 2016, aimed at describing the main clinical and echocardiographic characteristics in them. In the series women (64.7 percent) and the 40-49 age group (33.3 percent) prevailed; in 86.3 percent of the patients the tumor was in the left atrium, in 11.8 percent, in the right atrium and 1.9 percent, in the left ventricle. In all those affected patients the echocardiogram (bidimensional and Doppler) was the method of decisive diagnosis and the irreplaceable tool for decisions making of the cardiologist and cardiovascular surgeon(AU)

Uso de la ecocardiografía en el diagnóstico y tratamiento de pacientes con mixomas cardíacos / Use of echocardiogram in the diagnosis and treatment of patients with cardiac myxomata

Se realizó un estudio descriptivo, retrospectivo, de corte transversal, de 51 pacientes con tumores cardíacos intracavitarios de la variedad histológica mixoma, quienes fueron asistidos y operados en el Servicio de Cardiología y Cirugía Cardiovascular del Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" de Santiago de Cuba, en el período de enero de 1987 a igual mes de 2016, con vistas a describir las principales características clínicas y ecocardiográficas presentes en ellos. En la serie predominaron las mujeres (64,7 %) y las edades de 40-49 años (33,3 %); en 86,3 % de los pacientes el tumor se localizó en la aurícula izquierda, en 11,8 %, en la aurícula derecha y 1,9 %, en el ventrículo izquierdo. En todos los afectados la ecocardiografía (bidimensional y Doppler) resultó el método de diagnóstico determinante y la herramienta insustituible para la toma de decisiones del cardiólogo y del cirujano cardiovascula

A descriptive, retrospective, cross-sectional study, of 51 patients with intracavity cardiac tumors of the histologic variety myxoma who were assisted and operated in the Cardiology and Cardiovascular Surgery Service of "Saturnino Lora Torres" Teaching Clinical Surgical Provincial Hospital in Santiago de Cuba, was carried out from January, 1987 to the same month in 2016, aimed at describing the main clinical and echocardiographic characteristics in them. In the series women (64.7 %) and the 40-49 age group (33.3 %) prevailed; in 86.3 % of the patients the tumor was in the left atrium, in 11.8 %, in the right atrium and 1.9 %, in the left ventricle. In all those affected patients the echocardiogram (bidimensional and Doppler) was the method of decisive diagnosis and the irreplaceable tool for decisions making of the cardiologist and cardiovascular surgeon

Conventional polymerase chain reaction for the diagnosis of neurotoxoplasmosis: comparison of three sets of primers for the B1 gene using CSF samples.

Polymerase chain reaction (PCR) has made a significant improvement in the diagnosis of toxoplasmic encephalitis (TE). Nevertheless, a wide variety of targets and primers has been used in different assays, and few comparative studies had been carried out. The aim of the present study was to compare the efficiency of 3 conventional PCR methods by using 3 sets of primers targeting the repetitive B1 gene in the diagnosis of TE. Diagnostic sensitivity and specificity of PCR and nested-PCR protocols were assessed for 207 (nested-PCR/T1-T4), 200 (nested-PCR/S1-AS1), and 206 (PCR/B22-B23) cerebrospinal fluid (CSF) samples, including AIDS and HIV-negative patients. The diagnostic sensitivity of PCR and nested-PCR assays was 50.85%, 68.97%, and 72.41% for T1-T4, S1-AS1, and B22-B23, respectively. The diagnostic specificity was high for all the assays showing values between 95% and 97%. In general, the best results were obtained for the B22-B23 set of primers, suggesting their usefulness compared with 2 nested-PCR protocols and showing that this simple and rapid strategy may be the preferred one for the diagnosis of TE in AIDS patients.

Molecular diagnosis of Toxoplasma gondii infection in cerebrospinal fluid from AIDS patients.

BACKGROUND: Toxoplasmic encephalitis (TE) is one of the most common opportunistic infections in immunocompromised patients. In Cuba, despite the highly active antiretroviral therapy, TE is still the most important cause of cerebral mass lesions in patients infected with the human immunodeficiency virus (HIV). The detection of Toxoplasma gondii by PCR may facilitate the diagnosis and follow-up of TE in acquired immunodeficiency syndrome (AIDS) patients by direct identification of parasite DNA in clinical samples. The aim of the present study was to evaluate a rapid PCR method using the B1 gene to detect T. gondii in cerebrospinal fluid (CSF) samples from patients with suspected TE. METHODS: CSF samples from AIDS and HIV-negative patients were analyzed. Patients were divided into two groups according to the Centre for Disease Control and Prevention (CDC) criteria for AIDS-related TE: AIDS patients with suspected neurotoxoplasmosis and AIDS and HIV-negative patients with other confirmed neurological diseases but no suspicions of TE. Predictive values, diagnostic accuracy, sensitivity and specificity of the PCR B1 method were calculated. RESULTS: The results obtained from 190 patients showed that this assay has a good sensitivity and specificity (83.3% and 95.7%, respectively) for the diagnosis of TE in AIDS patients. CONCLUSION: PCR using the B1 gene and B22/B23 set of primers is a single, rapid and reliable method that may be valuable for discrimination between toxoplasmosis and other central nervous system (CNS) diseases.

Detection of Toxoplasma gondii in cerebrospinal fluid from AIDS patients by nested PCR and rapid identification of type I allele at B1 gene by RFLP analysis.

Highly active antiretroviral therapy (HAART) has decreased the incidence of opportunistic infections in the central nervous system (CNS) in AIDS patients. However, toxoplasmic encephalitis (TE) still represents the most common cerebral mass lesion in patients infected with human immunodeficiency virus (HIV). The aim of this study was to evaluate nested PCR-B1 using cerebrospinal fluid (CSF) to detect Toxoplasma gondii DNA for the diagnosis of TE. A total of 114 samples were evaluated, and 33/44 samples from patients with TE were positive by PCR (sensitivity 75%), demonstrating the diagnostic usefulness of PCR technique. PCR-B1 products were analyzed by restriction fragment length polymorphism (RFLP) in 30 samples. Only type I allele at B1 was identified in these samples according banding patterns. This is the first report of evaluation of S1-AS1/S2-AS2 set of primers in more than 100 clinical samples as well as the first genotyping study of T. gondii in Cuba.

El diagnóstico molecular de la infección de gondii de Toxoplasma en el líquido de cerebrospinal de pacientes de SIDA / Molecular diagnosis of Toxoplasma gondii infection in cerebrospinal fluid from AIDS patients

Toxoplasmic encephalitis (TE) is one of the most common opportunistic infections in immunocompromised patients. In Cuba, despite the highly active antiretroviral therapy, TE is still the most important cause of cerebral mass lesions in patients infected with the human immunodeficiency virus (HIV). The detection of Toxoplasma gondii by PCR may facilitate the diagnosis and follow-up of TE in acquired immunodeficiency syndrome (AIDS) patients by direct identification of parasite DNA in clinical samples. The aim of the present study was to evaluate a rapid PCR method using the B1 gene to detect T. gondii in cerebrospinal fluid (CSF) samples from patients with suspected TE(AU)

Comparison of four DNA extraction methods from cerebrospinal fl uid for the detection of Toxoplasma gondii by polymerase chain reaction in AIDS patients

BACKGROUND: Toxoplasmosis is a serious and often life-threatening disease in immunodeficient patients. Polymerase chain reaction (PCR) assays allow a rapid diagnosis of Toxoplasma infection by direct detection of the parasite's DNA. To perform a sensitive, specific, and reliable PCR-based diagnostic test, the availability of pure DNA lacking PCR inhibitors as well as a rapid and easy-to-perform DNA extraction protocol are essential. The aim of the present study was to compare four DNA extraction methods for the detection of T. gondii on cerebrospinal fluid (CSF) using the PCR technology. MATERIAL/METHODS: Four DNA extraction methods (boiling, lysis + centrifugation, the miniMAG commercial system, and phenol-chloroform) were compared with respect to the time of completion, the manual labor involved, and PCR analytical sensitivity for the detection of T. gondii in CSF. The optimal DNA extraction method for the detection of the parasite was evaluated in CSF from 43 AIDS patients using the nest-PCR B1 assay. RESULTS: According to the time required for completion, labor, and PCR analytical sensitivity, the lysis + centrifugation protocol proved to be a simple, efficient, and economical in-house procedure to recover the T. gondii DNA present in the CSF. The diagnostic sensitivity of nest-PCR, according to Centers for Disease Control and Prevention (CDC) criteria, was 86.3 percent and the diagnostic specificity was 100 percent. CONCLUSIONS: We report a simple, rapid, reproducible, and economical in-house method for T. gondii DNA extraction from CSF. This method is recommended for diagnostic PCR of Toxoplasmic encephalitis (TE) in places with economical shortage(AU)

ANTECEDENTES: La toxoplasmosis es una grave y, a menudo, las enfermedades que amenazan la vida en pacientes inmunodeficientes. Reacción en cadena de polimerasa (PCR) los ensayos de permitir un diagnóstico rápido de infección por Toxoplasma detección directa del ADN del parásito. Para realizar una sensible, específico y fiable basada en PCR-prueba de diagnóstico, la disponibilidad de ADN puro falta inhibidores de la PCR, así como una rápida y fácil de realizar el protocolo de extracción de ADN son esenciales. El objetivo del presente estudio fue comparar cuatro métodos de extracción de ADN para la detección de T. gondii en líquido cefalorraquídeo (LCR), utilizando la tecnología PCR. MATERIAL Y MÉTODOS: Cuatro métodos de extracción de ADN (punto de ebullición, + lisis centrifugación, el sistema comercial miniMAG, y fenol-cloroformo) con respecto a la hora de finalización, la mano de obra en cuestión, y PCR de análisis de sensibilidad para la detección de T. gondii en el LCR. El método óptimo de extracción de ADN para la detección del parásito se evaluó en el LCR de 43 pacientes con SIDA mediante el nido-PCR B1 ensayo. RESULTADOS: Según el tiempo necesario para la realización, la mano de obra, análisis de sensibilidad y la PCR, el protocolo de lisis centrifugación + demostrado ser un simple, eficiente y económico en el seno del procedimiento de recuperación de T. gondii de ADN presentes en el MCA. La sensibilidad diagnóstica de PCR-nido, de acuerdo con los Centros para Control y Prevención de Enfermedades (CDC) de los criterios, fue 86,3 por ciento y la especificidad diagnóstica fue del 100 por ciento. CONCLUSIONES: Se presenta un sencillo, rápido, reproducible y económica en el seno de un método de extracción de ADN T. gondii de PPC. Se recomienda este método de PCR para el diagnóstico de la encefalitis toxoplásmica (TE) en lugares con escasez económica(AU)

Comparison of four DNA extraction methods from cerebrospinal fluid for the detection of Toxoplasma gondii by polymerase chain reaction in AIDS patients.

BACKGROUND: Toxoplasmosis is a serious and often life-threatening disease in immunodeficient patients. Polymerase chain reaction (PCR) assays allow a rapid diagnosis of Toxoplasma infection by direct detection of the parasite's DNA. To perform a sensitive, specific, and reliable PCR-based diagnostic test, the availability of pure DNA lacking PCR inhibitors as well as a rapid and easy-to-perform DNA extraction protocol are essential. The aim of the present study was to compare four DNA extraction methods for the detection of T. gondii on cerebrospinal fluid (CSF) using the PCR technology. MATERIAL/METHODS: Four DNA extraction methods (boiling, lysis + centrifugation, the miniMAG commercial system, and phenol-chloroform) were compared with respect to the time of completion, the manual labor involved, and PCR analytical sensitivity for the detection of T. gondii in CSF. The optimal DNA extraction method for the detection of the parasite was evaluated in CSF from 43 AIDS patients using the nest-PCR B1 assay. RESULTS: According to the time required for completion, labor, and PCR analytical sensitivity, the lysis + centrifugation protocol proved to be a simple, efficient, and economical in-house procedure to recover the T. gondii DNA present in the CSF. The diagnostic sensitivity of nest-PCR, according to Centers for Disease Control and Prevention (CDC) criteria, was 86.3% and the diagnostic specificity was 100%. CONCLUSIONS: We report a simple, rapid, reproducible, and economical in-house method for T. gondii DNA extraction from CSF. This method is recommended for diagnostic PCR of Toxoplasmic encephalitis (TE) in places with economical shortage.