Infección tardía por estreptococo grupo B en gemelos nacidos mediante cesárea / Late-onset group B streptococcus disease in twins delivered by caesarean section

El estreptococo del grupo B (EGB) es un germen comensal de la microflora intestinal, bien conocido por producir infección invasiva precoz y tardía en el recién nacido. La transmisión de la infección precoz por EGB se produce de forma vertical, y la introducción de la profilaxis antibiótica intraparto en las últimas décadas ha supuesto una reducción drástica en la incidencia. Los avances en la prevención y conocimiento de los factores de riesgo de la infección tardía se encuentran estáticos desde hace varias décadas. La continua modificación y mejora de las guías sobre profilaxis, factores de riesgo y prevención de la infección precoz por EGB siguen sin abarcar la infección tardía por dicho patógeno. Los casos clínicos presentados ilustran la presencia de zonas grises en las recomendaciones clínicas actuales y en el conocimiento de la etiopatiogenia de la enfermedad tardía

Group B Streptococcus (GBS) is a commensal pathogen of the gut microflora with a well-established role in the aetiology of early and late onset GBS infections in the newborn. The incidence of early onset infections by vertical transmission has been drastically reducedin recent decades with the use of intravenous intrapartum prophylaxis. Progress in risk factor detection and prophylaxis of late-onset infection has however remained static. The ongoing modifications and improvements of the guidelines regarding prophylaxis, risk factors and prevention of the early-onset GBS disease have not addressed late-onset GBS infection in detail. The following cases illustrate the presence of grey areas in current guidelines and in the knowledge of the pathogenesis of late-onset disease

Importancia del seguimiento a largo plazo de la diabetes insípida; de hipofisitis linfocitaria a germinoma / Importance of long-term follow-up of diabetes insipidus; from lymphocytic hypophysitis to germinoma

Se describe el caso de un trastorno del eje hipotálamo hipofisario en un niño de 10 años que comenzó con diabetes insípida y evolucionó a un panhipopituitarismo. En estos casos siempre se debe sospechar una lesión hipotalámica oculta y realizar seguimiento. A los 3 años, se detectó la aparición de lesiones en el tallo hipofisario. Los marcadores tumorales fueron negativos pero la lesión creció y fue biopsiada. El resultado anatomopatológico fue de hipofisitis linfocitaria. En el seguimiento hubo un aumento de los marcadores tumorales, por lo que se realizó una nueva biopsia que fue diagnóstica de germinoma. La hipofisitis linfocitaria es muy rara en estas edades y algunos casos son diagnosticados finalmente de germinoma. El interés radica en resaltar la importancia del seguimiento de los casos de diabetes insípida central y en cuestionar un posible diagnóstico de hipofisitis linfocitaria, o mejor infundibuloneurohipofisitis linfocitaria, muy raro en estas edades y que puede enmascarar un germinoma, con muy pocos casos reportados

A case is presented of a 10-year old boy who had a hypothalamic-pituitary axis disorder. He initially presented with diabetes insipidus that progressed to panhypopituitarism. A hidden hypothalamic lesion should be suspected in all these cases, and should be followed up. New lesions were found in the pituitary stem three years later. Although tumor markers were negative, there was an increase in size, and a biopsy was performed. The histopathology reported a Lymphocytic Hypophysitis. There were increases in the tumor markers during the follow-up, thus a second biopsy was performed, with the diagnosis of Germinoma. Lymphocytic Hypophysitis is an uncommon diagnosis in children. Few cases have been reported, and in some cases, they were later diagnosed with Germinoma. We believe this case highlights the importance of the follow-up of children with Central Diabetes Insipidus with a normal MRI, as well as not taking the diagnosis of Lymphocytic Hypophysitis/ lymphocytic Infundibular neurohypophysitis as definitive, as it is a rare diagnosis at thisage, and could mask a Germinoma, as recorded in some cases

[Late-onset Group B Streptococcus disease in twins delivered by caesarean section]. / Infección tardía por estreptococo grupo B en gemelos nacidos mediante cesárea.

Group B Streptococcus (GBS) is a commensal pathogen of the gut microflora with a well-established role in the aetiology of early and late onset GBS infections in the newborn. The incidence of early onset infections by vertical transmission has been drastically reduced in recent decades with the use of intravenous intrapartum prophylaxis. Progress in risk factor detection and prophylaxis of late-onset infection has however remained static. The ongoing modifications and improvements of the guidelines regarding prophylaxis, risk factors and prevention of the early-onset GBS disease have not addressed late-onset GBS infection in detail. The following cases illustrate the presence of grey areas in current guidelines and in the knowledge of the pathogenesis of late-onset disease.

[Importance of long-term follow-up of diabetes insipidus; from lymphocytic hypophysitis to germinoma]. / Importancia del seguimiento a largo plazo de la diabetes insípida; de hipofisitis linfocitaria a germinoma.

A case is presented of a 10-year old boy who had a hypothalamic-pituitary axis disorder. He initially presented with diabetes insipidus that progressed to panhypopituitarism. A hidden hypothalamic lesion should be suspected in all these cases, and should be followed up. New lesions were found in the pituitary stem three years later. Although tumor markers were negative, there was an increase in size, and a biopsy was performed. The histopathology reported a Lymphocytic Hypophysitis. There were increases in the tumor markers during the follow-up, thus a second biopsy was performed, with the diagnosis of Germinoma. Lymphocytic Hypophysitis is an uncommon diagnosis in children. Few cases have been reported, and in some cases, they were later diagnosed with Germinoma. We believe this case highlights the importance of the follow-up of children with Central Diabetes Insipidus with a normal MRI, as well as not taking the diagnosis of Lymphocytic Hypophysitis/lymphocytic Infundibular neurohypophysitis as definitive, as it is a rare diagnosis at this age, and could mask a Germinoma, as recorded in some cases.

Treatment of severe cold-induced urticaria in a child with omalizumab

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Sistema de triaje y evaluación de Urgencias pediátricas / Pediatric Emergency Department trige system

En las últimas décadas, se a registrado un aumento progresivo de las consultas a los Servicios de Urgencias hospitalarios. De ahí surge la necesidad de optimizar la organización de los mimos e instaurar sistemas de clasificación de los pacientes. El objetivo del trabajo es evaluar el funcionamiento de nuestro servicio y del sistema de triaje de Manchester en nuestro medio. Material y métodos. Se realizó una revisión de historias clínicas de las urgencias pediátricas atendidas durante el año 2009. Se registraron datos descriptivos y epidemiológicos y se estudiaron indicadores de calidad definidos por la SEUP e indicadores relacionados con el sistema de triaje. Resultados. El número total de urgencias atendidas fue de 23.173. el 32,7% de ellas han sido atendidas en el último trimestre del año, con una clara afluencia máxima en las últimas horas de la tarde. Con respecto a los indicadores de calidad, se cumplen los estándares en clasificación de pacientes, peticiones de radiología, porcentaje de ingresos y de readmisión. El 95,3% de los pacientes se clasificaron en los niveles 4 y 5. Existe una adecuada correlación entre el nivel de gravedad, el porcentaje de exploraciones complementarias y la tasa de hospitalización. Discusión. La utilización de un sistema de triaje informatizado es fundamental tanto para la selección de aquellos pacientes que requieren ser atendidos con mayor celeridad como para poder valorar la calidad de nuestros servicios de urgencias, los cuales se hallan colapsados mayoritariamente por patología banal (AU)

During the last decades, a progressive increase of the episodes visited in the emergency services has been reported. Thereefore, the optimization of the organization of these services in essential. The objective of this article is to evaluate the working our pediatric emergency unit and the applicability of the Manchester's triage system. Material and methods. We did a review of the Pediatric Urgency episodes visited during 2009. Descriptive and epidemiologic characteristics were registered and quality indicators defined by the SEUP and other quality indicators about the triage system were examinated. Results. The total number of episodes visited in the emergency services was 23, 173, 32,7% of them were visited during the last trimester of the year and mostly in the afternoon. The quality indicators reached were the standard of classification, the solicitude of radiology, the percentage of hospitalization and the percentage of readmitted patients. 95,3% of the patients were classified as level 4 and 5. It existed a good correlation between gravity level, percentage of complementary explorations and hospitalization rate. Conclusion. The use of a computerized triage system is essential in order to select those patients who have to be visited quickly and for the evaluation of the working of the emergency services (AU)