Diagnostic and therapeutic approach to spondylodiscitis in Spanish children through the RIOPed network: evaluation before and after the publication of the national consensus document.

OBJECTIVE: Pediatric spondylodiscitis (PSD) is an uncommon condition, for which there are no specific international clinical guidelines. Factors related to complications have not been stablished. Our aim was to describe clinical and epidemiological characteristics of PSD, to analyze factors associated with complications and to evaluate adherence to the recommendations of the Spanish National Consensus Document (NCD) for the diagnostic and therapeutic approach to acute osteoarticular infections. MATERIAL AND METHODS: Ambispective, multicenter, national study of two PSD cohorts: historical (2008-2012) and prospective (2015-2020, after publication of NCD). Patients with diagnosis of PSD were included. Demographic, clinical, microbiological and radiological data were recorded. Factors related to the development of complications were analized by logistic regression. Comparisons between both cohorts were performed. RESULTS: Ninety-eight PSD were included. In 84.7%, diagnosis was confirmed by magnetic resonance imaging. Microbiological isolation was obtained in 6.1%, with methicillin-sensitive S. aureus as the main etiologic agent. Complications occurred in 18.9%, the most frequent being soft tissue abscess. Of the 8.6% of patients with sequelae, persistent pain was the most common. Comparing cohorts, there was better adherence to NCD treatment recommendations in the prospective one (57.6% vs. 12.9%, p < 0.01), including a reduction in the length of intravenous antibiotic therapy (10 vs. 14 days, p < 0.01). CONCLUSIONS: The evolution of PSD in our series was favorable, with low frequency of complications and sequelae. The adherence to the recommendations of the NCD was high. Studies with larger sample size are needed to establish new recommendations to optimize the approach to these infections.

Clinical Experience with Abemaciclib in Patients Previously Treated with Another CDK 4/6 Inhibitor in a Tertiary Hospital: A Case Series Study.

The three approved cyclin-dependent kinase 4/6 (CDK4/6) inhibitors, including abemaciclib, have shown differences in their preclinical, pharmacological, and clinical data. Abemaciclib stands out for its broader target range and more rapid and intense activity. It has demonstrated efficacy as a monotherapy or in combination with tamoxifen in endocrine-refractory metastatic breast cancer (MBC) patients with prior chemotherapy. However, the clinical data on abemaciclib after exposure to previous CDK4/6 inhibitors are limited. In this single-center retrospective case series, we identified all patients who received abemaciclib until February 2022 after experiencing documented progression on palbociclib or ribociclib. The safety profile and clinical outcomes of abemaciclib treatment in this specific patient cohort were evaluated. Eleven patients were included in this retrospective case series, nine receiving abemaciclib with tamoxifen. Eight patients had visceral involvement, and the median age was 69 (ranging from 42 to 84). The median time from the end of prior CDK4/6 inhibitor treatment to abemaciclib initiation was 17.5 months (ranging from 3 to 41 months). Patients had undergone a median of three prior therapies (ranging from 1 to 7), including chemotherapy in 54.5% of cases. The median follow-up time was six months (ranging from 1 to 22 months). The median progression-free survival (PFS) was 8 months (95% CI 3.9-12). Five patients continued abemaciclib treatment, and one patient with liver metastases achieved a complete hepatic response. The most common adverse events were diarrhea (72.7%, no grade ≥ 3) and asthenia (27.3%, no grade ≥ 3). Our preliminary findings suggest that abemaciclib could be an effective and safe treatment option for MBC patients who have previously received palbociclib or ribociclib.

Adherence of Spanish pediatricians to "do not do" guidelines to avoid low-value care in pediatrics.

The main objective of this study was to analyze the degree of knowledge and compliance of Spanish pediatricians with the "do not do" recommendations of the Spanish Association of Pediatrics. A nationwide cross-sectional, descriptive study was carried out using a 25-item questionnaire among Spanish pediatricians. Univariate, bivariate, and multivariate analyses were performed. A total of 1137 pediatricians participated in the study. Most of them were women (75.1%), older than 55 (28.3%), worked in specialized care (56.9%), with public financing (91.2%), and had been working for more than 20 years (44.9%). The median of inappropriate answers per question was 9.1%. The bivariate and multivariate analyses showed that the factors that influenced higher adequacy to the "do not do" recommendations were younger than 45 years, working in specialized care, and working in the public health system. CONCLUSION: This research is the first nationwide study in Spain to analyze the adequacy of "do not do" pediatric clinical recommendations. The study showed a high level of compliance by Spanish pediatricians with these recommendations. However, there is a lack of knowledge in less frequent infectious pathologies such as HIV or fungal infections, in not prolonging antibiotic treatment unnecessarily and directing it appropriately according to the antibiogram results. These aspects may be improved by designing measures to enhance pediatricians' knowledge in these specific aspects. Some demographical factors are related to higher adequacy. Performing this research in other countries may allow assessing the current clinical practice of pediatricians. WHAT IS KNOWN: • Low-value care is defined as care that delivers little or no benefit, may cause patients harm, or outcomes marginal benefits at a disproportionately increased cost. • Few nationwide studies have assessed adherence to "do not do" guidelines, especially in pediatric settings. WHAT IS NEW: • Albeit there is a high level of compliance by Spanish pediatricians with the «do not do¼ recommendations, there is a lack of knowledge in different aspects that may be improved. • Some demographical factors are related to higher adequacy. Performing this research in other countries may allow assessing the current clinical practice of pediatricians.

Matrix Metalloproteinases and Their Inhibitors in Pulmonary Fibrosis: EMMPRIN/CD147 Comes into Play.

Pulmonary fibrosis (PF) is characterized by aberrant extracellular matrix (ECM) deposition, activation of fibroblasts to myofibroblasts and parenchymal disorganization, which have an impact on the biomechanical traits of the lung. In this context, the balance between matrix metalloproteinases (MMPs) and their tissue inhibitors of metalloproteinases (TIMPs) is lost. Interestingly, several MMPs are overexpressed during PF and exhibit a clear profibrotic role (MMP-2, -3, -8, -11, -12 and -28), but a few are antifibrotic (MMP-19), have both profibrotic and antifibrotic capacity (MMP7), or execute an unclear (MMP-1, -9, -10, -13, -14) or unknown function. TIMPs are also overexpressed in PF; hence, the modulation and function of MMPs and TIMP are more complex than expected. EMMPRIN/CD147 (also known as basigin) is a transmembrane glycoprotein from the immunoglobulin superfamily (IgSF) that was first described to induce MMP activity in fibroblasts. It also interacts with other molecules to execute non-related MMP aactions well-described in cancer progression, migration, and invasion. Emerging evidence strongly suggests that CD147 plays a key role in PF not only by MMP induction but also by stimulating fibroblast myofibroblast transition. In this review, we study the structure and function of MMPs, TIMPs and CD147 in PF and their complex crosstalk between them.

Asociación de crisis febriles e infección por enterovirus y parechovirus humano en urgencias pediátricas: estudio piloto / Association between febrile seizures and enterovirus and parechovirus infection in the emergency room: A pilot study

No disponible

Accuracy of 18F-FDG PET/CT in patients with the suspicion of cardiac implantable electronic device infections.

BACKGROUND: Utility of 18F-FDG PET/CT in diagnosing infective endocarditis (IE) associated with cardiac implantable electronic devices (CIEDs) is not well established. Current ESC guidelines recommend the use of FDG-PET imaging in patients with CIEDs and positive blood cultures, but the number of studies evaluating the diagnostic performance of FDG-PET imaging in these patients remain limited. Our objective was to assess the diagnostic yield of 18F-FDG PET/CT in patients with suspected CIED infections, differentiating between pocket infection (PI) and lead infection (CIED-IE). METHODS AND RESULTS: From 2013 to 2018, all patients (n = 63) admitted to a hospital with suspected CIED infection were prospectively recruited, undergoing a diagnostic work-up including a PET/CT. Explanted devices and material from the pocket were cultured. 14 cases corresponded to isolated PI and 13 were categorized as CIED-IE. Considering radionuclide uptake in the intracardiac portion of the lead, sensitivity and specificity of PET/CT for CIED-IE were 38.5% and 98.0%, respectively. Positive (19.2) and negative (0.6) likelihood ratio values, suggest that a positive PET/CT is much more probable to correspond to a patient with CIED-IE, whereas it is not possible to exclude this diagnosis when negative. For PI, sensitivity and specificity were 72.2% and 95.6%, respectively. CONCLUSIONS: The yield of 18F-FDG PET/CT for suspected CIED infections differs depending on the site of infection. Due to very high specificity but poor sensitivity, negative studies must be interpreted with caution if the suspicion of CIED-IE is high.

Incidental Findings Suggestive of COVID-19 Pneumonia in Oncologic Patients Undergoing 18F-FDG PET/CT Studies: Association Between Metabolic and Structural Lung Changes.

Although the novel coronavirus disease 2019 (COVID-19) can present as nonspecific clinical forms, subclinical cases represent an important route of transmission and a significant source of mortality, mainly in high-risk subpopulations such as cancer patients. A deeper knowledge of the metabolic shift in cells infected with severe acute respiratory syndrome coronavirus 2 could provide new insights about its pathogenic and host response and help to diagnose pulmonary involvement. We explored the potential added diagnostic value of 18F-FDG PET/CT scans in asymptomatic cancer patients with suspected COVID-19 pneumonia by investigating the association between metabolic and structural changes in the lung parenchyma. Methods:18F-FDG PET/CT studies acquired between February 19 and May 29, 2020, were reviewed to identify those cancer patients with incidental findings suggestive of COVID-19 pneumonia. PET studies were interpreted through qualitative (visual) and semiquantitative (measurement of SUVmax) analysis evaluating lung findings. Several characteristic signs of COVID-19 pneumonia on CT were described as COVID-19 Reporting and Data System (CO-RADS) categories (1-6). After comparing the SUVmax of pulmonary infiltrates among different CO-RADS categories, we explored the best potential cutoffs for pulmonary SUVmax against CO-RADS categories as the gold standard result to eliminate the possibility that the diagnosis of COVID-19 pneumonia exists. Results: On multimodal PET/CT imaging, CT signs classified as CO-RADS category 5 or 6 were found in 16 of 41 (39%) oncologic patients. SUVmax was higher in patients with categories 5 and 6 than in patients with category 4 (6.17 ± 0.82 vs. 3.78 ± 0.50, P = 0.04) or categories 2 and 3 (3.59 ± 0.41, P = 0.01). A specificity of 93.8% (95% CI, 71.7%-99.7%) and an accuracy of 92.9% were obtained when combining a CO-RADS score of 5 or 6 with an SUVmax of 2.45 in pulmonary infiltrates. Conclusion: In asymptomatic cancer patients, the metabolic activity in lung infiltrates is closely associated with several combined tomographic changes characteristic of COVID-19 pneumonia. Multimodal 18F-FDG PET/CT imaging could provide additional information during early diagnosis in selected predisposed patients during the pandemic. The prognostic implications of simultaneous radiologic and molecular findings in cancer patients and other subpopulations at high risk for COVID-19 pneumonia deserve further evaluation in prospective research.

Impact of Coronavirus Pandemic on Tuberculosis and Other Imported Diseases Screening among Migrant Minors in Spain.

BACKGROUND: In recent decades, the increase in population movements has turned the focus to imported diseases. The COVID-19 pandemic has negatively impacted the access to health care systems, especially in highly vulnerable populations. We address the effects of the pandemic on the health screening of migrant unaccompanied minors (UM) in Spain. METHOD: Retrospective cross-sectional study including UM screened for imported diseases with a unified protocol at a pediatric reference unit for tropical and infectious diseases in Madrid, Spain. We compared the pre-pandemic (2018-2019) and post-pandemic periods (2020-2021). RESULTS: A total of 192 minors were screened during the study period, with a drop in UM's referral to our center in the post-pandemic years (140 in 2018-2019 vs. 52 in 2020-2021). Out of 192, 161 (83.9%) were diagnosed with at least one medical condition. The mean age was 16.8 years (SD 0.8) and 96.9% were males. Most cases were referred for a health exam; only 38% of children were symptomatic. Eosinophilia was present in 20.8%. The most common diagnosis were latent tuberculosis infection (LTBI) (72.9%), schistosomiasis (15.1%), toxocariasis (4.9%) and strongyloidiasis (4.9%). The prevalence of LTBI did not vary significantly (69.3% vs. 82.7%, p = 0.087). A total of 38% of the patients diagnosed with LTBI never started treatment or were lost to follow-up, as were two out of three patients with active pulmonary tuberculosis. CONCLUSIONS: In this series, the number of UM referred for health screening has dropped dramatically after the COVID pandemic, and two years after the beginning of the pandemic, access to care is still limited. Lost to follow-up rates are extremely high despite institutionalization. Specific resources, including multidisciplinary teams and accessible units are needed to improve diagnoses and linkage to care in this vulnerable population.

El niño con patología crónica y complejidad: ¿cuál es el camino? / Children with medical complexity. What is the way?

No disponible

El impacto de la nutrición en la salud periodontal: revisión narrativa sobre mitos y realidades / Nutrition´s impact on periodontal health: narrative review on myths and realities

El tipo de alimentación que seguimos en nuestra vida cotidiana puede afectar a nuestra salud general y oral. De hecho, una dieta inadecuada se considera un factor de riesgo de las enfermedades crónicas no transmisibles entre las que se encuentra la periodontitis. Aunque los mecanismos patogénicos involucrados se deben determinar con exactitud, parece que la clave del proceso es la capacidad que tiene una alimentación poco saludable de condicionar la respuesta inflamatoria. Para aclarar mitos y realidades que rodean la relación entre la salud periodontal y la alimentación se realiza esta revisión narrativa de los conocimientos actuales. Para ello es necesario preguntarse cómo la respuesta inflamatoria puede ser modificada por la ingesta continuada de determinados alimentos, y cómo esa respuesta inflamatoria alterada puede participar en la patogénesis de la periodontitis. Las dietas ricas en hidratos de carbono refinados y/o en grasas saturadas y trans son capaces de inducir inflamación. Y esa respuesta inflamatoria hiperactivada participa de forma activa en la patogénesis de las periodontitis, contribuyendo a la destrucción de los tejidos periodontales. (AU)

The diet that we follow daily can affect our general and oral health. In fact, an inadequate diet is considered a risk factor for chronic non-communicable diseases, including periodontitis. Although the pathogenic mechanisms involved must be determined exactly, it seems that the key to the process is the ability of an unhealthy diet to condition the inflammatory response. To clarify myths and realities surrounding the relationship between periodontal health and diet, this narrative review of current knowledge is carried out. For this, it is necessary to ask ourselves how the inflammatory response can be modified by the continued intake of certain foods, and how this altered inflammatory response can participate in the pathogenesis of periodontitis. Diets rich in refined carbohydrates and / or saturated and trans fats are capable of inducing inflammation. And that hyperactivated inflammatory response actively participates in the pathogenesis of periodontitis, contributing to the destruction of periodontal tissues. (AU)

Off-label use of T2Candida® test in vitreous humor for diagnosing invasive candidiasis: a clinical report.

Here, we present a case of off-label successful use of the T2 MR (T2Candida® test) for the diagnosis of invasive candidiasis (Candida albicans endolphthalmitis). This case demonstrates that T2Candida could be performed in sterile body fluids to improve microbiological diagnosis of invasive candidiasis.

Situación actual del paciente pediátrico con patología crónica compleja: una experiencia entre atención primaria y hospitalaria / Current situation of children with medical complexity: An experience between primary and hospital care

Objetivo: Analizar la valoración de la atención a los niños con patología crónica compleja (NPCC) en atención primaria (AP), desde el punto de vista de sus médicos y de sus familias. Diseño: Estudio observacional, descriptivo y transversal. Emplazamiento: Pediatría de AP y unidad de patología crónica compleja (UPCC) del Hospital Universitario La Paz (HULP). Participantes: Pacientes y familiares de la UPCC y sus médicos de AP de la Comunidad de Madrid (CAM). Intervenciones: Realización de encuestas validadas presenciales y online. Mediciones principales: Grado de satisfacción en la formación, capacitación y manejo específico del NPCC según escalas tipo Likert. Resultados: Se encuestaron 53 familias y 170 médicos de AP (96,5% pediatras). Los resultados de la encuesta a familiares revelan descoordinación entre niveles asistenciales (73,6%), escasa confianza en el primer nivel asistencial e impresión de poca capacidad de resolución de problemas por parte de pediatría de AP (50%). Entre los médicos de AP destaca la poca formación para el seguimiento de los NPCC (96,5%), escasa experiencia en su manejo (93%) e insuficiente comunicación con el hospital (80,5%). La falta de tiempo en las consultas es un problema común, percibido por pediatras y pacientes. Conclusiones: La falta de coordinación entre AP y atención hospitalaria (AH) se detecta como un problema importante en la continuidad asistencial de NPCC. Son necesarias intervenciones que mejoren esta coordinación. La AP es cercana a la familia, pero precisa mejorar la formación y capacitación de los profesionales en problemas de salud y soporte tecnificado de NPCC, así como incrementar el tiempo necesario para su atención.(AU)

Objective: To analyze the assessment of the care of children with medical complexity (CMC) in Primary Care (PC), from the point of view of their doctors and their families. Design: Observational, descriptive and transversal study. Site: PC Pediatrics and Complex Chronic Pathology Unit (UPCC) of Hospital Universitario La Paz (HULP). Participants: Patients and relatives of the UPCC and their PC physicians of the Community of Madrid (CAM). Interventions: Face-to-face and online validated surveys were conducted. Main measurements: Degree of satisfaction in the training, education and specific management of the CMC according to Likert-type scales. Results: Fifty-three families and 170 PC physicians (96.5% pediatricians) were surveyed. The results of the family survey reveal lack of coordination between levels of care (73.6%), little confidence in the first level of care, and an impression of poor problem-solving capacity by PC pediatricians (50%). Among PC physicians, there is little training in the follow-up of CMC (96.5%), little experience in their management (93%) and insufficient communication with the hospital (80.5%). Lack of time in consultations is a common problem, perceived by pediatricians and patients. Conclusions: The lack of coordination between PC and Hospital Care is detected as an important problem in the continuity of care at CMC. Interventions are needed to improve this coordination. The PC is close to the family but needs to improve the education and training of professionals in health problems and technical support from CMC, as well as increase the time necessary for their care.(AU)

[Current situation of children with medical complexity: An experience between primary and hospital care]. / Situación actual del paciente pediátrico con patología crónica compleja: una experiencia entre atención primaria y hospitalaria.

OBJECTIVE: To analyze the assessment of the care of children with medical complexity (CMC) in Primary Care (PC), from the point of view of their doctors and their families. DESIGN: Observational, descriptive and transversal study. SITE: PC Pediatrics and Complex Chronic Pathology Unit (UPCC) of Hospital Universitario La Paz (HULP). PARTICIPANTS: Patients and relatives of the UPCC and their PC physicians of the Community of Madrid (CAM). INTERVENTIONS: Face-to-face and online validated surveys were conducted. MAIN MEASUREMENTS: Degree of satisfaction in the training, education and specific management of the CMC according to Likert-type scales. RESULTS: Fifty-three families and 170 PC physicians (96.5% pediatricians) were surveyed. The results of the family survey reveal lack of coordination between levels of care (73.6%), little confidence in the first level of care, and an impression of poor problem-solving capacity by PC pediatricians (50%). Among PC physicians, there is little training in the follow-up of CMC (96.5%), little experience in their management (93%) and insufficient communication with the hospital (80.5%). Lack of time in consultations is a common problem, perceived by pediatricians and patients. CONCLUSIONS: The lack of coordination between PC and Hospital Care is detected as an important problem in the continuity of care at CMC. Interventions are needed to improve this coordination. The PC is close to the family but needs to improve the education and training of professionals in health problems and technical support from CMC, as well as increase the time necessary for their care.

Clinical relevance of incidental focal breast uptake on fluorine-18 fluorodeoxyglucose PET/computed tomography studies: an experience in a high-load center of Spain.

AIM: We aimed to determine the frequency and clinical significance of breast incidental uptake (BIU) detected through fluorine-18 fluorodeoxyglucose (18F-FDG) PET/computed tomography (CT) in a single, high-load center. PATIENTS AND METHODS: In this retrospective study, we analyzed a total of 13 763 PET/CT studies performed from January 2017 to January 2020. After excluding 3148 scans, the maximum standardized uptake value (SUVmax) and maximum diameter (cm) of each BIU were measured. Clinical management, ultrasound/mammography and pathology reports were analyzed. RESULTS: We found BIU in 27 scans of 26 patients (0.3% of the studies). Mean age was 62.2 years and 88.5% were women; 84.6% underwent PET/CT for oncological indications. Ultrasound/mammography was consequently performed in 23 patients (88.5%), and histological correlations were available for Breast Imaging Reporting and Data System categories 4 and 5. Finally, lesions were benign in 14 patients (60.9%; two of them with low/intermediate risk of malignancy) and malignant in nine patients (39.1%). The remaining three patients had no ultrasound/mammography reports. Mean SUVmax of benign and malignant lesions were 2.6 ± 1.4 and 5.8 ± 3.5, respectively (P = 0.002). Considering a SUVmax cut-off value of 4.0, the sensitivity and specificity for differentiating benign vs. malignant lesions were 67 and 93%, respectively. Benign lesions were smaller than malignant in CT (maximum diameter:1.3 ± 0.5 cm vs. 2.0 ± 1.0 cm, P = 0.02). CONCLUSION: Although BIU detected by 18F-FDG PET/CT is infrequently found, the risk of malignancy remains very high (39.1%). Both SUVmax and maximum diameter were greater in malignant than in benign lesions. An exhaustive study with ultrasound/mammography and selective histopathological correlation is mandatory after BIU findings, even in small lesions.

Assessment of extra-parenchymal lung involvement in asymptomatic cancer patients with COVID-19 pneumonia detected on 18F-FDG PET-CT studies.

BACKGROUND: Lung involvement in patients with coronavirus disease 2019 (COVID-19) undergoing PET-CT has been previously reported. However, FDG uptake outside lung parenchyma was poorly characterized in detail. We evaluated the extra-parenchymal lung involvement in asymptomatic cancer patients with COVID-19 pneumonia through 18F-FDG PET-CT. METHODS: A total of 1079 oncologic 18F-FDG PET-CT were performed between February 2 and May 18, 2020. Confirmed COVID-19 pneumonia was defined as characteristic ground-glass bilateral CT infiltrates and positive genetic/serologic tests. Nonmetastatic extra-parenchymal lung PET-CT findings were evaluated through qualitative (visual), quantitative (measurements on CT), and semiquantitative (maximum standardized uptake value: SUVmax on PET) interpretation. Clinical data, blood tests, and PET-CT results were compared between patients with and without COVID-19 pneumonia. RESULTS: A total of 23 18F-FDG PET-CT scans with pulmonary infiltrates suggestive of COVID-19 and available laboratory data were included: 14 positive (cases) and 9 negative (controls) for COVID-19 infection, representing a low prevalence of COVID-19 pneumonia (1.3%). Serum lactate dehydrogenase and D-dimers tended to be increased in COVID-19 cases. Extra-parenchymal lung findings were found in 42.9% of patients with COVID-19, most frequently as mediastinal and hilar nodes with 18F-FDG uptake (35.7%), followed by incidental pulmonary embolism in two patients (14.3%). In the control group, extra-pulmonary findings were observed in a single patient (11.1%) with 18F-FDG uptake located to mediastinal, hilar, and cervical nodes. Nasopharyngeal and hepatic SUVmax were similar in both groups. CONCLUSION: In cancer patients with asymptomatic COVID-19 pneumonia, 18F-FDG PET-CT findings are more frequently limited to thoracic structures, suggesting that an early and silent distant involvement is very rare. Pulmonary embolism is a frequent and potentially severe finding raising special concern. PET-CT can provide new pathogenic insights about this novel disease.