Adecuación del diagnóstico y tratamiento de la faringoamigdalitis aguda a las guías actuales / Appropriateness of diagnosis and treatment of acute pharyngotonsillitis to current guidelines

Introducción: la faringoamigdalitis aguda (FAA) es una de las enfermedades más comunes en la infancia. El manejo diagnóstico y terapéutico es sencillo y, desde 2011, está consensuado. El objetivo principal es analizar la adecuación al consenso en un hospital de media complejidad, donde trabaja uno de los autores de dicho documento de consenso. Pacientes y métodos: estudio descriptivo, transversal, unicéntrico y de ámbito local. Se realiza un análisis retrospectivo de los informes de alta y pruebas complementarias en todos los niños ≤ 14 años diagnosticados de FAA en Urgencias Pediátricas. Periodo: del 1 de enero al 31 de diciembre de 2015. Resultados: se analizan 176 FAA (el 52,3%, niñas). La valoración clínica se realiza siempre mediante la escala de McIsaac. El 46,5% recibieron antibióticos antes de la realización de una técnica de detección rápida de antígeno estreptocócico o cultivo, en todos ellos. El 100% de los antibióticos y dosis prescritas se ajustaron al consenso. Los intervalos de dosis y la duración del tratamiento fueron adecuados en > 85% de los casos. Las prescripciones inadecuadas fueron pautadas por solo dos de los 17 pediatras del hospital. Conclusiones: la adecuación es superior a lo descrito en otras series. El uso apropiado de antibióticos puede mejorar mediante la formación continuada y regular por parte de pediatras especializados en enfermedades infecciosas. Además, se sugiere que los tratamientos inadecuados se analicen según prescriptor, para seleccionar qué facultativos deben recibir una formación específica. Es prioritario adecuar la prescripción de antimicrobianos en la FAA a la evidencia científica en nuestro país (AU)

Introduction: acute tonsillopharyngitis (ATP) is one of the most common childhood diseases. The diagnosis and therapeutic management is simple. Further, a consensus document exists in Spain since 2011. The aim of this study is to analyze the appropriateness to consensus in a general hospital, where an author of the consensus document is working. Patients and methods: a descriptive, cross-sectional, single-center and local study was conducted from January to December 2015. All children ≤ 14 years diagnosed as ATP in the Pediatric Emergency room were included. Clinical records and complementary tools were retrospectively studied. Results: a total of 176 ATP were analyzed (52.3% girls). Clinical assessment was always performed by McIsaac score. After conducting culture or a rapid antigen-detection test, 46.5% of children received antibiotics. Selection of antimicrobials and prescribed doses were 100% adjusted to consensus. Dose ranges and duration of treatment were >85% appropriated. Only two of 17 pediatricians working on the hospital were responsible of inappropriate prescriptions. Conclusions: appropriateness is higher than reported in other studies. Rational use of antibiotics could be improved through continuous and regular training by experts in pediatric infectious diseases. In addition, it is suggested to analyze inappropriate prescribers to select pediatricians that should receive specific training. In Spain, it is of primordial importance to adapt the prescribing of antibiotics to the scientific evidence (AU)

Factores de riesgo que influye en el bajo peso al nacer en el área de salud Olivos del municipio de Sancti Spiritus en los años 1998-2002

Se realizó un estudio control, de los factores de riesgos maternos, asociados al bajo peso al nacer, en el municipio de Sancti Spíritus, en el bienio 2002- 2003; incluyó una muestra de 100 casos y 200 controles de historias clínicas y registros de partos, así como una encuesta a las madres, con previo consentimiento. El modelo multivariado final, identificó como factores de riesgo significativos de bajo peso al nacer: la rotura prematura de membrana, la ganancia de peso en el embarazo de menos de 8kg, así como la hipertensión arterial; los cuales deben tenerse en cuenta, con el propósito de promover acciones de salud, que puedan revertir favorablemente estos indicadores en la comunidad y minimizar sus consecuencias[AU]

A control sutdy was made of maternal risk factors associated with lowbirthweight in the municipality of Sancti Spíritus in the years 2002-2003. This study included a sample of 100 cases and 200 controls from patient files and birth records, as well as from a survey to mothers with previous consent.The final multivariate model identified as significant risk factors of low birthweight premature rupture of membrane, weight gain during pregnancy lower than 8 kg, as well as hypertension, which must be taken into account with the aim of promoting health activities which can favorably change these results in the community and minimize their consequences(AU)

The interaction of Vatairea macrocarca and Rhizobium tropici: net H+ efflux stimulus and alteration of extracellular Na+ concentration.

We studied the effect of a lectin isolated from seeds of the legume Vatairea macrocarpa on net H+ efflux in Rhizobium tropici, a bacterium capable of nodulating legume Phaseolus vulgaris. V. macrocarpa lectin (VML) was observed to temporarily stimulate the specific net H(+) efflux in R. tropici. When VML was present at 32 microg ml(-1), with or without 2 microM galactose (Gal), a specific net efflux >2.4 pM H+(min)(-1) mg dry biomass(-1) was induced. There was no detectable net H+ efflux when bovine serum albumin (16 microg ml(-1)) was tested. Addition of 16 microgVMLml(-1) resulted in a 700% increase of the extracellular Na+ concentration. The soluble proteins in the supernatant containing VML extract indicate a maximum immobilization of +/-10 microgVMLml(-1), with a minimum of 36,600 dimers or 8500 larger aggregates of VML binding in each bacterium. Our data suggest that VML activates Rhizobium as a bioenergetic substrate molecule, resulting in potential alterations of the external bacterial membrane.

Esplenectomía por enfermedad hematológica: seis años de experiencia en el Hospital ABC / Splenectomy in hematologic disease: six years experience at the ABC Hospital

Se realizó un estudio retrospectivo, observacional y longitudinal de casos atendidos en el Hospital ABC con enfermedad hematológica en un periodo de seis años. Se encontraron 16 pacientes cuyos diagnósticos fueron púrpura trombocitopénica idiopática en ocho (50 por ciento), linfoma no Hodking en tres (18.8 por ciento), síndrome de Evans en dos (12.5 por ciento), esferocitosis en uno (6.2 por ciento), leucemia de células peludas en uno (6.2 por ciento) y linfoma de MALT en el restante (6.2 por ciento). Se realizaron 13 procedimientos electivos y tres de urgencia, 13 por cirugía abierta (tiempo quirúrgico promedio 150 minutos) y tres mediante laparoscopia (tiempo quirúrgico promedio 315 minutos). Se encontraron bazos accesorios en 18.75 por ciento de los casos. La estancia hospitalaria fue similar en ambos grupos. El procedimiento laparoscópico tuvo una mayor morbi-mortalidad en comparación con la cirugía abierta. Se inmunizó con vacuna contra neumococo a seis pacientes durante su estancia hospitalaria. La cirugía para enfermedad hematológica tiene una morbi-mortalidad aceptable. Los pacientes que ameritan cirugía de urgencia deben ser sometidos a procedimientos abiertos.

Immunohistochemical detection and quantitation of cell surface receptors for prostanoids.

The mucosa of the colon occupies 25% of the intestinal wall, from the muscularis mucosa to the lumen-lining epithelium, and contains a variety of cell types, predominantly B and T lymphocytes, but also monocytes, mast cells, and macrophages (1,2). These cells secrete a variety of cytokines, including interleukins, leakotrienes, and prostaglandins. Most of these are locally active, diffuse throughout the mucosa, and do not substantially contribute to the concentration of cytokines in the blood.

Prostanoid receptors in intestinal epithelium: selective expression, function, and change with inflammation.

The tissue concentration of PGE(2)is heightened during mucosal inflammation. Nevertheless, the cellular targets of this prostanoid and its effects on epithelial cell physiology are incompletely understood. We used a panel of specific immunoglobulin and mRNA probes in order to localize and quantitate the four member EP family of prostanoid receptors for binding PGE(2)on cells of histologically normal and inflamed human colonic mucosa, and then examined the physiological consequences for the epithelial component of intestine, with special attention to its barrier function. Prostanoid receptors were selectively expressed on a limited number of human colonic mucosal cells, and differed markedly between normal and inflamed tissue. In non-inflamed mucosa, EP(2)and EP(3)were expressed on epithelia at the apex of crypts; while EP(4)was expressed on surface and lateral crypt epithelia. Dual immunostaining and in situ hybridization with digoxygenin-labelled RNA probes largely confirmed the epithelial localization of EP(4). On the other hand, during inflammation, lateral crypt (non-surface) epithelial cells newly and significantly expressed prostanoid receptors EP(2)and EP(3)(p<0.05, by computer-assisted densitometry). Functionally, exogenous E series prostanoids applied to epithelial monolayers in nM concentrations brought about a 24% increase in the level of barrier function; an associated rise in intracellular cAMP (EC(50)of 281); and protection of epithelium from the effects of T cell cytokines. A major perturbation in the number and distribution of functional eicosonoid receptors on epithelia occurs in chronic inflammation of human colonic mucosa.

Transforming growth factor beta1 ameliorates intestinal epithelial barrier disruption by Cryptosporidium parvum in vitro in the absence of mucosal T lymphocytes.

Exposure to oocysts of the protozoan Cryptosporidium parvum causes intestinal epithelial cell dysfunction in vivo and in vitro, but effective means by which mucosal injury might be prevented remain unclear. We examined the ability of transforming growth factor beta1 (TGF-beta1)-a cytokine synthesized and released by cells in the intestine-to preserve the barrier function of human colonic epithelia when challenged with C. parvum oocysts and then studied the mechanisms involved. Epithelial barrier function was monitored electrophysiologically, receptors for TGF-beta1 were localized by confocal microscopy, and TGF-beta1-induced protein kinase C activation was detected intracellularly by translocation of its alpha isozyme. TGF-beta1 alone enhanced intestinal epithelial barrier function, while exposure to C. parvum oocysts (> or =10(5)/monolayer) markedly reduced barrier function to < or =40% of that of the control. When epithelial monolayers were pretreated with TGF-beta1 at 5.0 ng/ml, the barrier-disrupting effect of C. parvum oocysts was almost completely abrogated for 96 h. Further investigation showed that (i) the RI and RII receptors for TGF-beta1 were present on 55 and 65% of human epithelial cell line cells, respectively, over a 1-log-unit range of receptor protein expression, as shown by flow cytometry and confirmed by confocal microscopy; (ii) only basolateral and not apical TGF-beta1 exposure of the polarized epithelial monolayer resulted in a protective effect; and (iii) TGF-beta1 had no direct effect on the organism in reducing its tissue-disruptive effects. In exploring mechanisms to account for the barrier-preserving effects of TGF-beta1 on epithelium, we found that the protein kinase C pathway was activated, as shown by translocation of its 80-kDa alpha isozyme within 30 s of epithelial exposure to TGF-beta1; the permeability of epithelial monolayers to passage of macromolecules was reduced by 42% with TGF-beta1, even in the face of active protozoal infection; and epithelial cell necrosis monitored by lactate dehydrogenase release was decreased by 50% 70 h after oocyst exposure. Changes in epithelial function, initiated through an established set of surface receptors, likely accounts for the remarkable barrier-sparing effect of nanogram-per-milliliter concentrations of TGF-beta1 when human colonic epithelium is exposed to an important human pathogen, C. parvum.

Prostanoids in human colonic mucosa: effects of inflammation on PGE(2) receptor expression.

Although the tissue concentration of PGE(2) is heightened 3-fold or more during mucosal inflammation, the cellular targets of prostanoids in human mucosa and the resulting changes in cell physiology have not been fully explored. We used a panel of immunoglobulin and mRNA probes in order to localize and quantitate the four member EP family of prostanoid receptors for binding PGE(2) to cells of histologically normal and inflamed human colonic mucosa, and then examined prostanoid-induced changes in mucosal lymphocyte function. Prostanoid receptors were selectively expressed on a limited number of human colonic mucosal cells; EP(4) alone was expressed on lamina propria mononuclear cells. Dual immunostaining in situ identified the CD3(+) T lymphocyte as a major EP(4) receptor-bearing cell in normal mucosa. Flow cytometry of isolated cells showed that 19.2% of lamina propria mononuclear cells were EP(4)(+), and almost 30% of these were CD3(+). In situ hybridization with digoxygenin-labeled RNA probes largely confirmed this localization. During inflammation, mucosal T lymphocytes showed a significant enhancement in EP(4) immunoreactive receptor protein. Computer-assisted densitometry of single cells demonstrated an increase in fluorescence intensity from 4.8 +/- 1.8 to 8.6 +/- 1.8 (p < 0.04). The effects of PGE(2) included a 35% reduction in T lymphocyte IL-2 secretion. COX 1(+) lamina propria cells nearly doubled in number during inflammation; expressed a T lymphocyte marker; but retained an unchanged quantity of immunoreactive COX 1 protein per cell. The number of newly appeared COX 2(+) lymphocytes remained <50% that of COX 1(+) cells. A major perturbation in the number and distribution of PGE(2) receptors and enzymes for prostanoid synthesis occurs in chronic inflammation of the colon, with consequences for mucosal T lymphocyte function.

Effects of ipsapirone and cannabidiol on human experimental anxiety.

The effects of ipsapirone and cannabidiol (CBD) on healthy volunteers submitted to a simulated public speaking (SPS) test were compared with those of the anxiolytic benzodiazepine diazepam and placebo. Four independent groups of 10 subjects received, under a double-blind design, placebo or one of the following drugs: CBD (300 mg), diazepam (10 mg) or ipsapirone (5 mg). Subjective anxiety was evaluated through the Visual Analogue Mood Scale (VAMS) and the State-trait Anxiety Inventory (STAI). The VAMS anxiety factor showed that ipsapirone attenuated SPS-induced anxiety while CBD decreased anxiety after the SPS test. Diazepam, on the other hand, was anxiolytic before and after the SPS test, but had no effect on the increase in anxiety induced by the speech test. Only ipsapirone attenuated the increase in systolic blood pressure induced by the test. Significant sedative effects were only observed with diazepam. The results suggest that ipsapirone and CBD have anxiolytic properties in human volunteers submitted to a stressful situation.