Uso del test rápido de detección de antígeno estreptocócico en la consulta de Atención Primaria / Use of the rapid antigen detection test for streptococcus in Primary Care

Introducción: la faringoamigdalitis aguda por Streptococcus pyogenes es uno de los diagnósticos más frecuentes en Pediatría. Para identificarla clínicamente se han propuesto varias escalas de predicción clínica (Centor y Centor modificada por McIsaac), pero para el diagnóstico etiológico se recomienda el uso del test rápido de detección antigénica de estreptococo. Este test tiene una alta sensibilidad y especificidad y es de fácil aplicación. Nuestro estudio tiene como objetivo conocer el uso de este test en la consulta de Pediatría de Atención Primaria de nuestra área de influencia. Material y métodos: se ha realizado un estudio observacional retrospectivo de todos los pacientes de las comarcas centrales de Cataluña con diagnóstico de faringoamigdalitis, faringitis aguda, amigdalitis estreptocócica y amigdalitis aguda desde el 1 de enero de 2015 al 31 de enero de 2016. Resultados: se han estudiado 12 678 episodios de faringoamigdalitis aguda estreptocócica en 10 276 pacientes. Se realizaron 1274 test rápido de detección (10,05%). El 47,02% resultó positivo. La escala de Centor modificada se registró en 1240 pacientes (9,78%); 6933 pacientes (53,81%) recibieron tratamiento antibiótico. Al 89,67% de estos no se les había realizado test rápido de detección. La amoxicilina fue el antibiótico más usado. Conclusiones: constatamos una baja utilización del test rápido de detección y un bajo registro de la escala de Centor. Se ha observado un uso excesivo de antibióticos, pero los antibióticos utilizados se adaptan a las recomendaciones de las guías terapéuticas (AU)

Introduction: acute pharyngitis caused by Streptococcus pyogenes is one of the most common diagnoses in pediatrics. To identify a clinical streptoccoccal acute pharyngitis, some predictive clinical scales have been proposed (Centor, Centor modified by McIsaac), but for the etiologic diagnosis, the use of the rapid antigen detection test for streptococcus is recommended. This test has a high sensitivity and specificity and it is easy to apply. Our study aims to determine the use of rapid antigen detection test in pediatric Primary Care in our area of influence. Material and methods: we designed a retrospective observational study of all patients of Central Catalonia with the diagnosis of pharyngitis, acute pharyngitis, streptococcal tonsillitis and acute tonsillitis from 1st January 2015 to 31st January 2016. Results: 12,678 episodes of streptococcal acute pharyngitis have been studied in 10,276 patients. 1274 (10.05%) rapid antigen detection tests were performed. Of them, 47.02% were positive. The modified Centor score was recorded in 1240 patients (9.78%); 6933 patients (53.81%) received antibiotic treatment. 89.67% of these patients had not undergone rapid antigen detection test. Amoxicillin was the most widely used antibiotic. Conclusions: we evidenced a low use of rapid antigen detection test and a low register of Centor score. It has been observed an overuse of antibiotics, but the antibiotic used follow the recommendations of the treatment guidelines (AU)

El reto de la inmigración: estudio en Atención Primaria / No disponible

Introducción: el aumento de la inmigración supone un reto para la Atención Primaria.El objetivo de este estudio es analizar las características sociofamiliares y sanitarias de losniños inmigrantes.Métodos: estudio: prospectivo observacional. Período: 01/01/02-31/12/03. Poblaciónde estudio: recién nacidos hijos de inmigrantes (RN) y niños inmigrantes (N) atendidos en elCentro de Atención Primaria (CAP) de Manlleu (Barcelona). Variables: país de procedencia;características sociofamiliares y sanitarias. Análisis estadístico SPSS®, comparación entre variables:test de χ2 y test de Fisher.Resultados: datos poblacionales: se atendió a 281 niños, 82% marroquíes; 139 del grupode RN y 142 del grupo N. El 34% de los recién nacidos fueron hijos de inmigrantes, el 93% deMarruecos. Procedencias del grupo N: 71,8% Marruecos, 17% América Latina y 7,7% paísesde Europa del Este. Datos sociofamiliares: padres: tiempo de inmigración mayor de 10 años:51,8% (RN) frente al 6,3% (N) (p < 0,01); necesidad de intérprete: 2,9% (RN) y 6,3% (N);trabajan el 84,2% (RN) y el 79,6% (N). Madres: necesidad de intérprete: 43,2% (RN) frente al57,7% (N) (p < 0,015); trabajan el 7,2% (RN) y el 17,6% (N) (p = 0,025); 3 hijos: 37,4%(RN) frente al 59,2% (N) (p < 0,01). Consanguinidad: 24% en ambos grupos. Vivienda enpropiedad: 44% (RN) frente al 27,5% (N) (p < 0,03).Datos sanitarios: caries: 46%; anemias: 13%; hepatitis A curada: 20%; infección por elvirus de la hepatitis B: 4%; parasitosis intestinales: 7%; prueba de tuberculina positiva: 4%;raquitismo: 0%. En total se detectó patología, excluyendo la caries, en el 28%, todos asintomáticos.Conclusiones: elevado porcentaje de recién nacidos hijos de inmigrantes. La principal procedenciaes Marruecos. Las diferencias observadas en las variables sociofamiliares sugierenque el grupo RN adquiere modelos similares a los de la población de acogida. Las patologíasmás prevalentes son las anemias y las enfermedades infecciosas

Introduction: the increase in immigration is a challenge for Primary Attention. The aimofthis study is to analyse the social and health characteristics of immigrant children.Methods: study: observational prospective. Period: 01/01/02-31/12/03. Study population:recently arrived children of immigrants (RN) and immigrant children (N) attended inthe Primary Care Centre (CAP) in Manlleu (Barcelona). Variables: country of origin; social,family and health characteristics. Statistical analysis SPSS®, comparison between variables:χ2 test and Fisher test.Results: population data: 281 children were attended, 82% Moroccan; 139 RN and 142 N.34% of the recent arrivals were the children of immigrants, 93% Moroccan. Origins of group N:71.8% Morocco, 17% Latin America and 7.7% countries of Eastern Europe. Social and familydata: fathers: immigration time > 10 years: 51.8% (RN) as opposed to 6.3% (N) (p < 0.01); needfor interpreters: 2.9% (RN) and 6.3% (N); in work 84.2% (RN) and 79.6% (N). Mothers: needfor interpreter: 43.2% (RN) as opposed to 57.7% (N) (p < 0.015); in work 7.2% (RN) and 17.6%(N) (p = 0.025); 3 children: 37.4% (RN) with respect to 59.2% (N) (p < 0.01). Consanguinity:24% in both groups. Dwelling owned: 44% (RN) as opposed to 27.5% (N) (p < 0.03).Health data: tooth decay: 46%; anaemia: 13%; hepatitis A cured: 20%; hepatitis B viralinfection: 4%; intestinal parasites: 7%; PPD positive: 5.6%; tuberculous illness: 1.4%; rickets:0%. Excluding tooth decay, pathologies were found in 28%, all asymptomatic.Conclusions: a large percentage of recently arrived children of immigrants. The mainoriginis Morocco. The differences observed in the social and family variables suggest that theRN group acquires models similar to those of the receiving population. The most preva-lentpathologies are anaemia and infectious illnesses (AU)

[Autochthonous yeasts isolated in Tenerife wines and their influence on ethyl acetate and higher alcohol concentrations analyzed by gas chromatography]. / Levaduras autóctonas aisladas en vinos de Tenerife y su influencia en las concentraciones de acetato de etilo y alcoholes superiores analizados por cromatografía de gases.

A taxonomic study of yeasts present on Tenerife wines, (Tacoronte-Acentejo Specific Denomination) has been carried out. Nine species of the genera: Saccharomyces, Torulaspora, Brettanomyces, Kluyveromyces, Debaryomyces, Saccharomycodes, Hansenula, Pichia and Candida have been isolated. Parallely we analysed volatile compounds of the wines such as ethyl acetate, methanol, isobutanol and amylic alcohols by gas chromatography. Appreciable quantities of ethyl acetate were detected due to the low fermentative power of species such as Candida glabrata and Debaryomyces hansenii. The greatest concentration of amylic alcohols were found in wines containing yeast with high alcohol producing power like Saccharomyces cerevisiae.

[Aortic coarctation in the neonatal period. Study of 137 cases]. / Coartación aórtica en el período neonatal. Estudio de 137 casos.

The clinical records of 137 newborns, diagnosed by cardiac catheterization of aortic coarctation, have been reviewed. According to the presence of associations, three different groups have been established. Group A: isolated coarctation or coarctation associated with patient ductus arteriosus (40 cases); Group B: coarctation associated with ventricular septal defect or atrial septal defect (37 cases); Group C: coarctation associated with other complex congenital cardiac lesions (60 cases). The aortic coarctation has been surgically repaired in 73 cases, by using the following techniques: End-to-end anastomosis in 26 patients, Waldhausen repair in 43 and other procedures in the remaining 4 cases. For the surgically treated patients the survival has been: 88% in group A, 90% in group B and 48% in group C. In non-operated patients the survival has been: 21%, 6% and 14%, respectively.

[Comparison of thiopental and propofol in short-duration anesthesia]. / Comparación entre tiopental y propofol en anestesias de corta duración.

Forty healthy females, 18 to 65 years, undergoing diagnostic or therapeutic uterine curettage were studied with the purpose of comparing anesthetic characteristics of thiopental and propofol as induction agents. They were randomly allocated in two groups: A propofol induction group (2.5 mg/kg), and a thiopental induction group (4-5 mg/kg). Fentanyl (2 micrograms/kg), was administered 2 minutes before anaesthesia, and N2O/O2 (66%/33%) by mask was maintained during surgery. Changes in systolic and diastolic BP were not significantly different in two groups. The HR decreased more significantly in the propofol group (20% vs 10%; p less than 0.005). Apnea was significantly greater in the propofol group, in term of incidence (50% vs 15%; p = 0.025), and duration (92 seg vs 17 seg; p = 0.20). The lapses of time to opening the eyes and response to a command were not significantly different, but the time to be able to seat was significantly lower in the propofol group (12 min vs 21 min; p = 0.0003). Anaesthesia was clinically satisfactory for most patients in both treatment groups.

[Transurethral resection using glycine irrigation]. / Résection endoscopique sous irrigation de glycine.

An accident is described which occurred during a transurethral resection of a prostatic adenoma using a 1.5% glycine solution in a 68 yr old patient. The surgery was performed under spinal anaesthesia with bupivacaine. After 14 l of irrigation fluid had been used, visual disturbances, bilateral mydriasis and drowsiness appeared, with no haemodynamic disturbances. Three hours after the end of surgery, there appeared convulsions, with the blood sodium level at 118 mmol X l-1. Symptomatic treatment resolved the problem, and the clinical examination was normal 12 h after surgery. The role of hyponatraemia in the clinical state is discussed. The usefulness of regional anaesthesia in the early detection of this type of accident is recalled.