Vitamina C, tiamina e hidrocortisona: ¿aliados en shock séptico? / Vitamin C, thiamine and hydrocortisone: allies against septic shock?

Objetivo: Determinar la efectividad del uso de un protocolo de vitamina C, tiamina e hidrocortisona en shock séptico a las dosis empleadas en el estudio Marik. Método: Estudio observacional retrospectivo antes-después que compara dos grupos de pacientes con shock séptico: grupo tratamiento (GT), tratado con el protocolo, desde enero 2019 a mayo 2020, frente a un grupo control (GC) en un periodo previo. Los objetivos principales fueron la supervivencia a los 14 y a los 28 días. Resultados: Se incluyeron 91 pacientes, 44 en GC y 47 en GT. No se encontraron diferencias estadísticamente significativas en la supervivencia a los 14 ni a los 28 días ni en la duración de estancia hospitalaria ni en la Unidad de Reanimación (REA) (p>0,05). La variación de los valores de creatinina entre los días 1 y 4 presentó una mediana de -0,04 (RIC -0,24;0,8) en el GC frente a -0,3 del GT (RIC -0,079;-0,03), p<0,05. Los valores de procalcitonina descendieron en el 27,3% de los pacientes del GC frente al 91,5% del GT (p<0,05). La necesidad de soporte vasoactivo con noradrenalina fue del 93% GC vs 76,6% GT en el día 2; 75% GC vs 55,3% GT en el día 3; 50% GC vs 27,7% GT en el día 4 (p<0,05). Conclusiones: Los datos de nuestro estudio muestran un beneficio limitado del uso del protocolo en pacientes con shock séptico, pero son necesarios estudios de mayor reclutamiento con un diseño prospectivo randomizado para asegurar el beneficio real y/o dosis óptimas. (AU)

Objective: To determine the effectiveness of using a protocol of vitamin C, thiamine and hydrocortisone for the treatment of septic shock at the doses used in the Marik study. Methods: Retrospective observational before-after study comparing two groups of patients with septic shock: treatment group (GT), treated with the protocol, between January 2019 and May 2020, versus a control group (GC) in a previous period. The primary outcomes were 14-Day and 28-Day Survival. Results: 91 patients were included, 44 in GC and 47 in GT. No statistically significant differences were found in 14-day and 28-day survival, in length of hospital or Resuscitation Unit (REA) stay (p>0.05). The median creatinine variation between days 1 and 4 was -0.04 (IQR -0.24;0.8) in the GC vs -0.3 in the GT (IQR -0.079; -0.03) (p<0.05). Procalcitonin values decreased in 27.3% of GC versus 91.5% of GT (p<0.05). The need for vasoactive drugs (noradrenaline) was 93% in GC vs 76.6% GT on day 2; 75% GC vs 55.3% GT on day 3; 50% GC vs 27.7% GT on day 4 (p<0.05). Conclusions: Our results show a limited benefit of the use of the protocol in patients with septic shock, but larger recruitment studies with a prospective randomized design are needed to ensure real benefit and/or optimal doses. (AU)

[Detection of epidemics from the Compulsory Disease Report. The case of measles in Las Palmas]. / Detección de epidemias a partir de las Enfermedades de Declaración Obligatoria. El caso del sarampión en Las Palmas.

The system of Compulsory Disease Reports (CDR) is an epidemiological monitoring regarding cases of contagious diseases which has been in use in Spain for over forty years. In 1982, new additions were made to the list of diseases for which a report is to be filed and, since that time, it was insisted upon that the centers falling under the National Health Institute be included among those having to file said reports. Nevertheless, many physicians question the need for this system and its usefulness. The cases of measles for which reports were filed in the province of Las Palmas from 1983 to 1988 were studied. Two waves of epidemics, occurring in early 1983 and in mid-1988, were observed, being patently distinguished from the noise of the reports between. Both waves of epidemics coincide with the hospitalization of cases of measles-related pneumonia in the pediatric hospital of that province. Based on these waves of epidemics, the importance of carrying out accurate measles vaccination studies for immunizing the populations against this disease is implied. The epidemiological importance of this CDR system is discussed both from a historic point of view and from that of epidemiological monitoring, and the need of drawing up and using operational definitions for each one of the diseases which is to be reported is reiterated. In conclusion, a positive evaluation of the usefulness of the CDR system, in spite of its current limitations, is provided, for which reason the importance of continuing to improve this system is stressed.

[Clinical effectiveness of antimeasles vaccine in Canarias. A case-control study]. / Eficacia clínica de la vacuna antisarampionosa en Canarias. Un estudio caso-control.

During 1988 an outbreak of measles occurred in Gran Canaria Island. Since a certain number of cases occurred in vaccinated children, a case control study of the efficacy of measles vaccine was carried out. Fourty six cases of children aged from 15 months to 7 years were studied together with 46 age, sex, and neighbourhood matched controls. The studied cases were children who came to the Pediatric Emergency Room of the Hospital Materno-Infantil, Las Palmas, and were diagnosed of measles from the 23rd February 1988 to the 30th June 1988. The control group was formed by the first child that came to this Emergency Room right after each of the children of the measles group presenting traumatological or surgical pathology and that could be properly matched. Both measles and control children were included in the study without information about their vaccination status. In this population, the clinical efficacy of measles vaccine, corrected in order to calculate that corresponding to a cohort study given the similarity of excess reasons in the matched and not matched 2 by 2 tables, was 76.0% (confidence interval 95%: 30.4% to 85.4%). The clinical efficacy calculated by us is somewhat inferior to the 90% usually reported in the literature, nevertheless, the vaccine still has a clear, statistically significant protective effect. We believe that this diminished efficacy could be due, amongst other reasons, to a break in the cooling system or to a smaller seroconversion index in our subtropical climate. We suggest this latter aspect should be studied in detail.

[The demand for emergency services at pediatric hospitals: a study of 4,858 cases treated at the emergency department of a pediatric hospital]. / Demanda urgente de asistencia pediátrica hospitalaria: estudio de 4.858 casos atendidos en el servicio de urgencias de un hospital infantil.

Given the rise in hospital emergencies, a detailed study of the demand for emergency pediatric care is a must. We compiled 4,858 medical records elected at random and gathered data about global activity in the emergency department of pediatric hospital. The demand for emergency pediatric care grows faster than the corresponding population. The higher and lower patient influxes were on Sunday and Wednesday respectively. The peak rate of influx was attained at 8 pm, whereas the low happened at 6 am. Pediatric emergencies diminish with age and are less frequent in girls than in boys. Only 15.86% of the patients had been referred by a physician. Fever and accidents were the most frequent reason for consultation. Ear, nose and throat diseases are at the top and double in frequency the bronchopulmonary sickness. Analyses were done in 12% of the cases, radiographs were taken in 23% of the patients and 68.58% of the casualties were taken were care of without any of these means. The visit was finished in a mean of 1.99 hours, a swift performance. Of all the cases studied, 93.4% were discharged and 5.3% were admitted to the same hospital. Our data confirm and complete the one published fragmentarily in the Spanish literature. We emphasize that a primary pediatrician could have spared the emergency department a lot of work. We conclude that accessible continuous care must be offered in order to transcend patchwork in following growth and development through pediatric emergency rooms.