ABSTRACT
OBJETIVO: Definir las características clínicas de los pacientes hospitalizados en servicios de medicina interna (MI) y neumología por exacerbaciones de la EPOC, evaluar la adecuación a las recomendaciones de las guías de práctica clínica y conocer su impacto en el pronóstico de los pacientes. METODOLOGÍA: Estudio longitudinal retrospectivo. Se incluyeron aleatoriamente pacientes ingresados por exacerbación de EPOC en un hospital de tercer nivel. Se registraron variables demográficas, clínicas (grado de disnea y de obstrucción, exacerbaciones previas, comorbilidades), criterios de adecuación a las guías clínicas GOLD y GesEPOC y datos de reingresos y mortalidad. Se realizó un análisis univariante, multivariante y de supervivencia. RESULTADOS: Se incluyeron 108 pacientes y la edad media fue de 71,48±11,65 años. Los reingresos a los 3 meses fueron un 26,4% y al año un 43,4%. La mortalidad intrahospitalaria fue del 3,9%, a los 3 meses del 21,9%, y al año del 27,4%. Los pacientes ingresados en MI tuvieron una mortalidad más elevada durante el ingreso (p = 0,043), a los tres meses (p = 0,028) y al año (p = 0,007) respecto a los de neumología. La adecuación global a las guías clínicas en la evaluación clínica fue del 63% (menor en los pacientes de MI: 56,1% vs. 73,8%, p = 0,063), y en el tratamiento del 26,9% para la GOLD, y del 28,7% para GesEPOC. La adecuación en el uso de corticoides según GOLD se asoció a menor tasa de reingresos al año (p = 0,041) y mortalidad intrahospitalaria (p = 0,007) y a los 3 meses (p = 0,05). CONCLUSIONES: El perfil clínico de los pacientes es actualmente similar al descrito previamente pero su evolución clínica fue peor. La adecuación global del tratamiento farmacológico a las guías clínicas es baja, y solo el uso adecuado de esteroides sistémicos se asocia a una reducción de la mortalidad precoz y de los reingresos a medio plazo
OBJECTIVE: To define the clinical characteristics of patients hospitalised in pneumology and internal medicine departments for chronic obstructive pulmonary disease (COPD) exacerbation, to assess the compliance with the recommendations of the clinical practice guidelines and to determine the impact on the patients' prognosis. METHODOLOGY: We conducted a retrospective longitudinal study that randomly included patients hospitalised for COPD exacerbation in a tertiary hospital. We collected demographic and clinical variables (degree of dyspnoea and obstruction, previous exacerbations, comorbidities), readmission and mortality data and criteria for compliance with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines and the Spanish COPD guidelines (GesEPOC). We performed a univariate, multivariate and survival analysis. RESULTS: The study included 108 patients, and the mean age was 71.48±11.65 years. The readmission rate was 26.4% at 3 months and 43.4% at 1 year. The hospital mortality rate was 3.9%, the mortality rate at 3 months was 21.9%, and the mortality rate at 1 year was 27.4%. The patients hospitalised in the internal medicine department had higher mortality during hospitalisation (p=.043), at 3 months (p=.028) and at 1 year (p=.007) compared with the rates for the pneumology department. Overall compliance with the clinical guidelines was 63% for the clinical evaluation (less for the patients in internal medicine: 56.1% vs. 73.8%, p=.063). For the treatment, the compliance was 26.9% for GOLD and 28.7% for GesEPOC. Compliance with the GOLD guidelines in the use of corticosteroids was associated with a lower rate of long-term readmissions (p=.041) and hospital mortality (p=.007) and 3-month mortality (p=.05). CONCLUSIONS: The clinical profile of the patients is currently similar to that previously reported, but their clinical progression was poorer. Overall compliance with the clinical guidelines for drug treatment was low, and only appropriate use of systemic steroids was associated with a reduction in early mortality and in medium-term readmissions
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Pulmonary Disease, Chronic Obstructive/complications , Symptom Flare Up , Pulmonary Disease, Chronic Obstructive/epidemiology , Disease Progression , Prognosis , Retrospective Studies , Patient Readmission/statistics & numerical data , Indicators of Morbidity and MortalityABSTRACT
OBJECTIVE: To define the clinical characteristics of patients hospitalised in pneumology and internal medicine departments for chronic obstructive pulmonary disease (COPD) exacerbation, to assess the compliance with the recommendations of the clinical practice guidelines and to determine the impact on the patients' prognosis. METHODOLOGY: We conducted a retrospective longitudinal study that randomly included patients hospitalised for COPD exacerbation in a tertiary hospital. We collected demographic and clinical variables (degree of dyspnoea and obstruction, previous exacerbations, comorbidities), readmission and mortality data and criteria for compliance with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines and the Spanish COPD guidelines (GesEPOC). We performed a univariate, multivariate and survival analysis. RESULTS: The study included 108 patients, and the mean age was 71.48±11.65 years. The readmission rate was 26.4% at 3 months and 43.4% at 1 year. The hospital mortality rate was 3.9%, the mortality rate at 3 months was 21.9%, and the mortality rate at 1 year was 27.4%. The patients hospitalised in the internal medicine department had higher mortality during hospitalisation (p=.043), at 3 months (p=.028) and at 1 year (p=.007) compared with the rates for the pneumology department. Overall compliance with the clinical guidelines was 63% for the clinical evaluation (less for the patients in internal medicine: 56.1% vs. 73.8%, p=.063). For the treatment, the compliance was 26.9% for GOLD and 28.7% for GesEPOC. Compliance with the GOLD guidelines in the use of corticosteroids was associated with a lower rate of long-term readmissions (p=.041) and hospital mortality (p=.007) and 3-month mortality (p=.05). CONCLUSIONS: The clinical profile of the patients is currently similar to that previously reported, but their clinical progression was poorer. Overall compliance with the clinical guidelines for drug treatment was low, and only appropriate use of systemic steroids was associated with a reduction in early mortality and in medium-term readmissions.
ABSTRACT
La displasia broncopulmonar (DBP) es la secuela más prevalente del recién nacido pretérmino, y sigue suponiendo un motivo frecuente de consulta en las unidades de Neumología Pediátrica. La decisión del alta de la unidad neonatal debe apoyarse en una valoración exhaustiva de la situación clínica del paciente y en el cumplimiento de unos requisitos, que incluyen la estabilidad respiratoria y nutricional, y la instrucción a los cuidadores en el manejo domiciliario. Para un control adecuado de la enfermedad, es necesario que quede establecido, previamente al alta, un calendario de visitas y de exploraciones complementarias, y deben aplicarse las pautas de prevención de exacerbaciones y el tratamiento apropiados. El concepto de DBP como enfermedad multisistémica es fundamental en el seguimiento de los pacientes y debe ser tenido en cuenta para un buen control de la enfermedad. En este documento, el Grupo de Trabajo de Patología Respiratoria Perinatal de la Sociedad Española de Neumología Pediátrica propone un protocolo que sirva como referencia para unificar el seguimiento de los pacientes con DBP entre los diferentes centros y ámbitos asistenciales. Se revisan los aspectos a tener en cuenta en la evaluación previa al alta de la Unidad Neonatal y las principales complicaciones durante el seguimiento. Seguidamente, se detallan las recomendaciones en materia de tratamiento de la enfermedad y prevención de complicaciones, los controles tras el alta y su cronología
Bronchopulmonary dysplasia (BPD) is the most common complication of preterm birth, and remains a major problem in pediatric pulmonology units. The decision of discharging from the Neonatal Unit should be based on a thorough assessment of the condition of the patient and compliance with certain requirements, including respiratory and nutritional stability, and caregiver education on disease management. For proper control of the disease, a schedule of visits and complementary tests should be established prior to discharge, and guidelines for prevention of exacerbations and appropriate treatment should be applied. In this paper, the Working Group in Perinatal Respiratory Diseases of the Spanish Society of Pediatric Pulmonology proposes a protocol to serve as a reference for the follow up of patients with BPD among different centers and health care settings. Key factors to consider when planning discharge from the Neonatal Unit and during follow up are reviewed. Recommendations on treatment and prevention of complications are then discussed. The final section of this guide aims to provide a specific schedule for follow-up and diagnostic interventions to be performed in patients with BPD
Subject(s)
Humans , Male , Female , Child , Bronchopulmonary Dysplasia/epidemiology , Bronchopulmonary Dysplasia/prevention & control , Clinical Protocols , Infant, Very Low Birth Weight , Infant, Premature, Diseases/diagnosis , Blood Gas Analysis/methods , Bronchopulmonary Dysplasia/complications , Bronchopulmonary Dysplasia/diagnosis , Bronchopulmonary Dysplasia/physiopathology , Follow-Up Studies , Infant, Premature/physiology , Health Status IndicatorsABSTRACT
Bronchopulmonary dysplasia (BPD) is the most common complication of preterm birth, and remains a major problem in pediatric pulmonology units. The decision of discharging from the Neonatal Unit should be based on a thorough assessment of the condition of the patient and compliance with certain requirements, including respiratory and nutritional stability, and caregiver education on disease management. For proper control of the disease, a schedule of visits and complementary tests should be established prior to discharge, and guidelines for prevention of exacerbations and appropriate treatment should be applied. In this paper, the Working Group in Perinatal Respiratory Diseases of the Spanish Society of Pediatric Pulmonology proposes a protocol to serve as a reference for the follow up of patients with BPD among different centers and health care settings. Key factors to consider when planning discharge from the Neonatal Unit and during follow up are reviewed. Recommendations on treatment and prevention of complications are then discussed. The final section of this guide aims to provide a specific schedule for follow-up and diagnostic interventions to be performed in patients with BPD.
Subject(s)
Bronchopulmonary Dysplasia/diagnosis , Follow-Up Studies , Humans , Infant, Newborn , Infant, Premature , Practice Guidelines as TopicABSTRACT
Introducción: La ventilación mecánica domiciliaria (VMD) es una técnica cada vez más frecuente en el niño. Existen pocos estudios que hayan analizado las características y necesidades de los niños sometidos a esta técnica. Material y métodos: Estudio descriptivo observacional transversal multicéntrico de pacientes entre un mes y 16 años dependientes de ventilación mecánica domiciliaria. Resultados: Se estudiaron 163 pacientes de 17 hospitales españoles con una edad media de 7,6 años. La causa más frecuente de VMD fueron los trastornos neuromusculares. El inicio de la VMD fue a una edad media de 4,6 años. Un 71,3% recibieron ventilación no invasiva. Los pacientes con ventilación invasiva tenían menor edad, menor edad de inicio de la VMD y mayor tiempo de uso diario. El 80,9% precisaban VM solo durante el sueño, y un 11,7% durante todo el día. Únicamente un 3,4% de los pacientes tiene asistencia sanitaria externa como ayuda a la familia. Un 48,2% es controlado en consultas específicas de VMD o consultas multidisciplinares. Un 72,1% de los pacientes está escolarizado (recibiendo enseñanza adaptada un 42,3%). Solo un 47,8% de los pacientes escolarizados cuentan con cuidadores específicos en su centro escolar. Conclusiones: La VMD en niños se utiliza en un grupo muy heterogéneo de pacientes iniciándose en un importante porcentaje en los primeros 3 años de vida. A pesar de que un significativo porcentaje de pacientes tiene una gran dependencia de la VMD pocas familias cuentan con ayudas específicas tanto a nivel escolar como en el domicilio, y el seguimiento sanitario es heterogéneo y poco coordinado(AU)
Introduction: Domiciliary mechanical ventilation (DMV) use is increasing in children. Few studies have analysed the characteristics of patients using this technique. Materials and methods: An observational, descriptive, transversal, multicentre study was conducted on patients between 1 month and 16 years of age dependent on domiciliary mechanical ventilation. Results: A total of 163 patients with a median age of 7.6 years from 17 Spanish hospitals were studied. The main reasons for DMV were neuromuscular disorders. The median age at beginning of DMV was 4.6 years. Almost three-quarters (71.3%) received non-invasive ventilation. Patients depending on invasive ventilation were younger, started DMV at an earlier age, and had more hours of mechanical ventilation per day. The large majority (80.9%) used DMV during sleep time only, and 11.7% during the whole day. Only 3.4% of patients had external health assistance. Just under half (48.2%) were being followed up in specific DMV or multidisciplinary clinics. Almost three-quarters (72.1%) of patients attended school (42.3% with adapted schooling). Only 47.8% of school patients had specific caregivers in their schools. Conclusions: DMV in children is used in a very heterogeneous group of patients, and in an important number of patients it is started before the third year of life. Despite there being a significant proportion of patients with a high dependency on DMV, few families receive specific support at home or at school, and health care surveillance is variable and poorly coordinated(AU)
Subject(s)
Humans , Male , Female , Child , Respiration, Artificial , Assisted Living Facilities/methods , Respiratory Insufficiency/therapy , Tracheostomy , Neuromuscular Diseases/complicationsABSTRACT
INTRODUCTION: Domiciliary mechanical ventilation (DMV) use is increasing in children. Few studies have analysed the characteristics of patients using this technique. MATERIALS AND METHODS: An observational, descriptive, transversal, multicentre study was conducted on patients between 1 month and 16 years of age dependent on domiciliary mechanical ventilation. RESULTS: A total of 163 patients with a median age of 7.6 years from 17 Spanish hospitals were studied. The main reasons for DMV were neuromuscular disorders. The median age at beginning of DMV was 4.6 years. Almost three-quarters (71.3%) received non-invasive ventilation. Patients depending on invasive ventilation were younger, started DMV at an earlier age, and had more hours of mechanical ventilation per day. The large majority (80.9%) used DMV during sleep time only, and 11.7% during the whole day. Only 3.4% of patients had external health assistance. Just under half (48.2%) were being followed up in specific DMV or multidisciplinary clinics. Almost three-quarters (72.1%) of patients attended school (42.3% with adapted schooling). Only 47.8% of school patients had specific caregivers in their schools. CONCLUSIONS: DMV in children is used in a very heterogeneous group of patients, and in an important number of patients it is started before the third year of life. Despite there being a significant proportion of patients with a high dependency on DMV, few families receive specific support at home or at school, and health care surveillance is variable and poorly coordinated.
Subject(s)
Home Care Services , Respiration, Artificial , Adolescent , Child , Child, Preschool , Cross-Sectional Studies , Female , Humans , Infant , Male , SpainABSTRACT
Los tests de función pulmonar son los métodos que se utilizan para conocer el funcionamiento de las vías aéreas y los pulmones. Existen diferentes métodos o técnicas para valorar la función pulmonar en niños colaboradores. Los test más frecuentemente utilizados en la práctica clínica son: la espirometría forzada con prueba brocodilatadora, tests broncodinámicos y flujo respiratorio máximo (FEM). La técnica de elección es la espirometría forzada con prueba broncodilatadora. Es la prueba más útil para el diagnóstico y seguimiento del asma. Es importante conocer que la espirometría forzada es el "patrón oro" para la medición de la función pulmonar en el niño. Permite clasificar las enfermedades pulmonares en obstructivas, restrictivas y mixtas. Por otro lado, la espirometría con prueba brocodilatadora es obligada para diagnosticar la obstrucción de la vía aérea, demostrar su reversibilidad, valorar la respuesta al tratamiento y monotorizar la evolución. La sintomatología, la espirometría forzada y la prueba de broncodilatación analizadas conjuntamente, permitirán establecer el diagnóstico e instaurar el tratamiento adecuado (AU)
Lung function test are the methods used to understand the functioning of the airways and lung. There are different methods or techniques for assessing lung function in collaborators children. The test most frequently used in clinical practice are forced spirometry with bronchodilator test, Test bronchodynamic and peak expiratory flow (PEF). The technique of choice is forced spirometry with bronchodilator test. It is the most useful test for the diagnosis and monitoring of asthma. It is important to know that spirometry with bronchodilator test. It is the most useful test for the diagnosis and monitoring of asthma. It is important to know that spirometry is the "gold standard" for measuring lung function in children. To classify obstructive lung diseases, restrictive and mixed. Moreover, spirometry with bronchodilator test is required to diagnose obstruction of the airway, demonstrating reversibility, assess response to treatment and monitor the evolution. Symptomatology, spirometry and bronchodilation test analyzed jointly will establish the diagnosis and institute the appropriate treatment (AU)
Subject(s)
Humans , Male , Female , Child , Spirometry , Bronchodilator Agents , Respiratory Tract Diseases/diagnosis , Patient Compliance , /methodsABSTRACT
El conducto (ductus) arterioso persistente (DAP) es una enfermedad frecuente en el prematuro. La indometacina intravenosa es el tratamiento estándar para su cierre, pero recientemente se ha empezado a utilizar el ibuprofeno intravenoso como alternativa o, incluso, como fármaco de primera elección, ya que algunas revisiones de evidencia Ahan mostrado igual eficacia, aunque menos oliguria y mayor porcentaje de enfermedad pulmonar crónica (EPC). Sin embargo, a pesar del cambio en la prescripción, también existe la apreciación clínica de mayor porcentaje de fracasos en los recién nacidos tratados con ibuprofeno. Este estudio pretende comparar ibuprofeno frente a indometacina en el cierre del DAP para evaluar su efectividad y seguridad. Material y métodos: se realizó un estudio retrospectivo transversal que abarcó el período comprendido desde el 01/01/2000 al 31/12/2004. Se evaluaron los casos diagnosticados de DAP en prematuros de bajo peso al nacer. Resultados: los resultados muestran que en el 62% de los casos donde se utilizó un cierre farmacológico se hizo con indometacina (en un período de 3 años) frente al 38% con ibuprofeno (en un período de 2 años). Los parámetros de eficacia muestran que el número de dosis necesaria para el cierre del DAP se duplica para el ibuprofeno, así como la necesidad de un nuevo ciclo de tratamiento. El porcentaje de reapertura de DAP fue de un 45,6% frente al 11,1% y el número de casos donde no se cerró el DAP también fue mayor para el ibuprofeno (9% frente al 0%). Otros parámetros como necesidad de cierre quirúrgico y porcentaje de fracaso a la semana de la primera dosis fueron similares para los dos fármacos. En cuanto a la seguridad los parámetros de EPC y mortalidad del recién nacido se muestran desfavorables para el ibuprofeno y en ninguno de los recién nacidos tratados se produjo oliguria. Conclusión: el ibuprofeno presenta algunos parámetros de eficacia desfavorables frente a indometacina, lo que incrementa su coste. En cuanto a la seguridad nuestros datos concuerdan con revisiones publicadas, aunque no se produjo oliguria con ninguno de los fármacos
Patent ductus arteriosus (PDA) is a frequent disease in the premature baby. Intravenous Indomethacin is the standard treatment used to close the duct but recently intravenous ibuprofen has been prescribed as an alternative or even a firstchoice drug because recent type Aevidence has shown it to be equally effective although with less oliguria and a large percentage of chronic pulmonary disease( CPD). However, with this change of prescription a higher percentage of failures in new-born children treated with Ibuprofen has been perceived. This study attempts to compare Ibuprofen with Indomethacin and to assess their safety and effectiveness in treating PDA. Material and methods: a cross-sectional retrospective study was carried out that included the period 01/01/2000 to 31/12/2004. The cases of PDA diagnosed in premature babies with low birth weight were evaluated. Results: the results show that in those cases where the duct was closed by pharmacological means 62% were treated with indomethacin (over a three year period) and 38% with ibuprofen (over a two year period). The parameters of effectiveness show that the number of doses needed to close the duct is double for Ibuprofen and a new cycle of treatment is required. The percentage of cases where the duct reopened was 45% with ibuprofen as opposed to 11% with indomethacin and the number of cases where the PDA failed to close was also greater with Ibuprofen (9% compared to 0%). Other parameters such as the need to close the PDA surgically and the percentage of failures a week after the first close were similar for both drugs. As regards safety the parameters of CPD and the mortality of the new-born babies were unfavourable for Ibuprofen although there was no evidence of oliguria in any of the children treated. Conclusions: ibuprofen, unlike Indomethacin, displays certain unfavourable parameters regarding its effectiveness and is also more costly. As far as safety is concerned our data agree with other published studies although oliguria did not take place with either of the drugs
Subject(s)
Male , Female , Infant, Newborn , Humans , Ductus Arteriosus, Patent/drug therapy , Cyclooxygenase Inhibitors/therapeutic use , Cardiovascular Agents/therapeutic use , Indomethacin/therapeutic use , Ibuprofen/therapeutic use , Treatment Outcome , Retrospective Studies , Cross-Sectional StudiesABSTRACT
OBJECTIVE: To study the capacity of renal acidification in a group of children diagnosed of idiopathic hypercalciuria. PATIENT AND METHODS: 36 children were studied, to those that were determined the pCO2 (UpCO2) maximum urinary with two different stimuli, acetazolamide and sodium bicarbonate (NaHCO3). At 33 of them, was performed an acidification test with frusemide stimulus. We studied a control group of 13 healthy children so much for the first one as the second tests and other 14 healthy children for the acidification test with frusemide. RESULTS: In the tests performed with NaHCO3 and acetazolamide stimulus, they were not proven differences in the values of UpCO2 neither in the urinary concentration of HCO3- (UHCO3-) than control children. Nevertheless, the UpCO2 and the concentration of UHCO3- in the patients were significantly lower with acetazolamide with regard to the NaHCO3 stimulus. In the acidification test with frusemide, significantly lower values of titratable acid and ammonium were obtained than control children. CONCLUSIONS: In children with idiopathic hypercalciuria, the capacity of secretion of H+ is normal, what is evidenced, especially, when studying the maximum UpCO2 after stimulus with NaHCO3. When diuretics are used as stimuli, exists more negative results that can be due to a certain partial resistance to the action of the same ones or to that are less potent to induce the secretion of H+.
Subject(s)
Calcium Metabolism Disorders/physiopathology , Calcium/urine , Kidney Tubules/physiopathology , Acidosis, Renal Tubular/diagnosis , Acidosis, Renal Tubular/physiopathology , Acidosis, Renal Tubular/urine , Adolescent , Calcium Metabolism Disorders/urine , Case-Control Studies , Child , Child, Preschool , Female , Humans , Hydrogen-Ion Concentration , MaleABSTRACT
Objetivo: Estudiar la capacidad de acidificación renal en un grupo de niños diagnosticados de hipercalciuria idiopática. Pacientes y Métodos: Se estudiaron 36 niños, a los que se les determinó la pCO2 (UpCO2) urinaria máxima con dos estímulos diferentes, acetazolamida y bicarbonato sódico (CO3HNa). A 33 de ellos, se les realizó una prueba de acidificación con estímulo de furosemida. Se estudiaron 13 controles tanto para la primera como la segunda pruebas y otros 14 para la prueba de acidificación con furosemida. Resultados: En la pruebas realizadas tanto con CO3HNa como con acetazolamida, no se comprobaron diferencias en los valores de UpCO2 ni en la concentración urinaria de CO3H- (UCO3H-) con respecto al grupo control. No obstante, la UpCO2 y la concentración de UCO3H- en los pacientes fueron significativamente inferiores con acetazolamida con respecto al estímulo de CO3HNa. En la prueba de acidificación con furosemida, se alcanzaron valores significativamente inferiores de acidez titulable y de amonio en relación al grupo control. Conclusiones: En niños diagnosticados de hipercalciuria idiopática, la capacidad de secreción de H+ es normal lo que se evidencia, especialmente, al estudiar la UpCO2 máxima con estímulo de CO3HNa. Cuando se utilizan diuréticos como estímulos, existen más resultados negativos, que pueden deberse a una cierta resistencia parcial a la acción de los mismos o a que son menos potentes para inducir la secreción de H+
Objective: To study the capacity of renal acidification in a group of children diagnosed of idiopathic hypercalciuria. Patient and Methods: 36 children were studied, to those that were determined the pCO2 (UpCO2) maximum urinary with two different stimuli, acetazolamide and sodium bicarbonate (NaHCO3). At 33 of them, was performed an acidification test with frusemide stimulus. We studied a control group of 13 healthy children so much for the first one as the second tests and other 14 healthy children for the acidification test with frusemide. Results: In the tests performed with NaHCO3 and acetazolamide stimulus, they were not proven differences in the values of UpCO2 neither in the urinary concentration of HCO3 - (UHCO3 -) than control children. Nevertheless, the UpCO2 and the concentration of UHCO3 - in the patients were significantly lower with acetazolamide with regard to the NaHCO3 stimulus. In the acidification test with frusemide, significantly lower values of titratable acid and ammonium were obtained than control children. Conclusions: In children with idiopathic hypercalciuria, the capacity of secretion of H+ is normal, what is evidenced, especially, when studying the maximum UpCO2 after stimulus with NaHCO3. When diuretics are used as stimuli, exists more negative results that can be due to a certain partial resistance to the action of the same ones or to that are less potent to induce the secretion of H+
Subject(s)
Male , Female , Child , Adolescent , Child, Preschool , Child, Preschool , Humans , Acidosis, Renal Tubular/diagnosis , Acidosis, Renal Tubular/physiopathology , Calcium/urine , Calcium Metabolism Disorders/physiopathology , Acidosis, Renal Tubular/urine , Calcium Metabolism Disorders/urine , Hydrogen-Ion Concentration , Kidney Tubules/physiopathologyABSTRACT
No disponible
Subject(s)
Female , Male , Child , Humans , Densitometry/methods , Kidney Diseases/complications , Kidney Diseases/diagnosis , Kidney Diseases , Acidosis, Renal Tubular/diagnosis , Calcitriol/administration & dosage , Calcitriol/therapeutic use , Urinary Calculi/complications , Urinary Calculi/diagnosis , Cytokines/administration & dosage , Cytokines/therapeutic use , Bone Diseases, Metabolic/complications , Bone Diseases, Metabolic/diagnosis , Chronic Kidney Disease-Mineral and Bone Disorder/complications , Chronic Kidney Disease-Mineral and Bone Disorder/diagnosis , Osteomalacia/diagnosis , Demineralization , Cystinosis/diagnosis , Osteosclerosis/complications , Osteosclerosis/diagnosisABSTRACT
Intracranial epidural abscesses are uncommon lesions, being more frequents in older children and adults. They commonly arise as a result of direct extension of a preexisting infection and rarely present with focal deficit. We present a case of a 11-days old preterm infant who developed an intracranial epidural abscess as a result of an infected scalp vein catheter. The diagnosis was made on the basis of the cranial ultrasound and CT scan images. An identified strain of Enterococcus faecium was cultured from all the samples. The patient underwent a right frontal craniotomy with drainage of the abscess and a 2-week total course of intravenous antibiotics was administrated. CT scan imaging 3 week after the procedure demonstrated no evidence of residual lesion. When present, a scalp vein catheter, in absence of others predisponing factors, must be considered as an etiologic agent for an intracranial epidural abscess in this age-group.
Subject(s)
Catheterization/adverse effects , Central Nervous System Bacterial Infections/etiology , Enterococcus faecium , Epidural Abscess/etiology , Frontal Lobe , Gram-Positive Bacterial Infections/etiology , Central Nervous System Bacterial Infections/diagnosis , Epidural Abscess/diagnosis , Gram-Positive Bacterial Infections/diagnosis , Humans , Infant, Newborn , Male , SkinSubject(s)
Diabetes Mellitus, Type 1/complications , Fanconi Syndrome/etiology , Calcium/urine , Diabetes Mellitus, Type 1/metabolism , Diabetes Mellitus, Type 1/physiopathology , Fanconi Syndrome/metabolism , Fanconi Syndrome/physiopathology , Humans , Kidney Tubules/pathology , Kidney Tubules/physiopathology , Magnesium/metabolism , Uric Acid/metabolismABSTRACT
No disponible
No disponible
