Crisis asmática en los servicios de urgencias en Espa˜na, ¿cuál es nuestra práctica habitual? / Asthma crisis in emergency departments in Spain: what is our usual practice?

Introducción: A pesar de la existencia de múltiples guías y documentos de consenso sobre el asma, persiste todavía una gran variabilidad en su abordaje, situación poco analizada en los Servicios de Urgencias (SU). Objetivo: Describir el manejo habitual de las crisis asmáticas en los SU españoles, conocer el grado de variabilidad entre sus diferentes profesionales y analizar los factores que pueden influir en su manejo. Material y métodos: Se elaboró un cuestionario, basado en supuestos clínicos, que se distribuyó entre los socios de la Sociedad Española de Urgencias de Pediatría y asistentes a la reunión en 2011. Resultados: Se analizan 300 encuestas. En 190 casos, el lugar de trabajo habitual es un hospital de tercer nivel. Existe una alta coincidencia en la valoración de la gravedad de los casos. Más del 90% utiliza beta 2 agonistas inhalados en la crisis asmática leve, el 75,3% utiliza corticoides orales en crisis moderadas y el 79% utiliza bromuro de ipratropio en las crisis graves. El 98% considera importante hacer educación terapéutica en los SU. Solo 8 (2,7%) utilizan la medición del pico de flujo espiratorio máximo. Los encuestados que trabajan en un hospital de tercer nivel utilizan con más frecuencia escalas de gravedad (90,5% vs. 80%, p = 0,009) y administran corticoides parenterales con menos frecuencia (53,2% vs. 66,4%, p = 0,017). Conclusiones: Aunque un porcentaje elevado de pediatras que trabajan en los SU siguen las guías de práctica clínica, se han detectado aspectos en los que el abordaje del asma es discordante entre los diferentes profesionales(AU)

Background: Despite there being various guidelines and consensus statements on asthma, great variability still exists in its treatment approach; although this has been little discussed in Emergency Departments (ED). Objective: To describe the usual management of asthma exacerbations in Spanish ED, and to determine the degree of variability among different professionals, as well as analyse factors that may influence their management. Material and methods: A questionnaire was developed based on clinical cases, which was distributed among members of the Spanish Society of Paediatric Emergencies and attendees at the meeting in 2011. Results: A total of 300 surveys were analysed. In 190 cases the place of work was in a tertiary care hospital. There was high agreement in the assessment of the severity of the cases mentioned. Over 90% use inhaled beta 2 agonists in mild asthma exacerbations, 75.3% used oral corticosteroids in moderate exacerbations, and 79% use ipratropium bromide in severe exacerbations. Almost all (98%) considered Therapeutic Education important in the Emergency Department. Only 8 (2.7%) used peak expiratory flow measurements. Respondents working in a tertiary hospital used severity scales more frequently (90.5% vs 80%, P=0.009) and administered parenteral corticosteroids less frequently (53.2% vs 66.4%, P=0.017). Conclusions: Although a high percentage of paediatricians working in the ED follow Clinical Practice Guidelines, some different points of the approach among professionals have been identified(AU)

[Asthma crisis in emergency departments in Spain: what is our usual practice?]. / Crisis asmática en los servicios de urgencias en España, ¿cuál es nuestra práctica habitual?

BACKGROUND: Despite there being various guidelines and consensus statements on asthma, great variability still exists in its treatment approach; although this has been little discussed in Emergency Departments (ED). OBJECTIVE: To describe the usual management of asthma exacerbations in Spanish ED, and to determine the degree of variability among different professionals, as well as analyse factors that may influence their management. MATERIAL AND METHODS: A questionnaire was developed based on clinical cases, which was distributed among members of the Spanish Society of Paediatric Emergencies and attendees at the meeting in 2011. RESULTS: A total of 300 surveys were analysed. In 190 cases the place of work was in a tertiary care hospital. There was high agreement in the assessment of the severity of the cases mentioned. Over 90% use inhaled ß2 agonists in mild asthma exacerbations, 75.3% used oral corticosteroids in moderate exacerbations, and 79% use ipratropium bromide in severe exacerbations. Almost all (98%) considered Therapeutic Education important in the Emergency Department. Only 8 (2.7%) used peak expiratory flow measurements. Respondents working in a tertiary hospital used severity scales more frequently (90.5% vs 80%, P=.009) and administered parenteral corticosteroids less frequently (53.2% vs 66.4%, P=.017). CONCLUSIONS: Although a high percentage of paediatricians working in the ED follow Clinical Practice Guidelines, some different points of the approach among professionals have been identified.

[Isolated conjunctival involvement in Langerhans cell histiocytosis]. / Histiocitosis de células de Langerhans con afectación conjuntival aislada.

CASE REPORT: A 43-year-old woman referred for a hyperemic node in the inferior conjunctival fornix. No improvement was observed after 10 days of antibiotic and anti-inflammatory topical treatment, so biopsy-extirpation was performed. Histopathological and immunohistochemical findings suggested the diagnosis of Langerhans cell histiocytosis (LCH). No findings of extraocular manifestations were shown after an intensive clinical and analytical investigation. DISCUSSION: LCH is a disease with different organ manifestations whose diagnosis depends on histological findings. We present a patient with isolated conjunctival affectation, which to our knowledge is the third case published in the literature.

Histiocitosis de células de Langerhans con afectación conjuntival aislada / Isolated conjunctival involvement in langerhans cell histiocytosis

Caso clínico: Mujer de 43 años que consulta por unnódulo hiperémico en fondo de saco conjuntivalinferior. Tras diez días de tratamiento antibiótico yantiinflamatorio tópico no se observa mejoría, porlo que se realiza una biopsia-extirpación. El resultadoanatomopatológico e inmunohistoquímico esinformado como histiocitosis de células de Langerhans(HCL), procediéndose a realizar un estudiosistémico con diferentes pruebas complementarias,sin hallar afectación a otro nivel.Discusión: La histiocitosis de células de Langerhanses una enfermedad de afectación muy variada,cuyo diagnóstico se establece mediante hallazgoshistológicos. Presentamos un caso de implicaciónexclusivamente conjuntival, habiéndose publicadosólo tres casos previamente en la literatura médica consultada(AU)

Case report: A 43-year-old woman referred for ahyperemic node in the inferior conjunctival fornix.No improvement was observed after 10 days ofantibiotic and anti-inflammatory topical treatment,so biopsy-extirpation was performed. Histopathologicaland immunohistochemical findings suggestedthe diagnosis of Langerhans cell histiocytosis(LCH). No findings of extraocular manifestationswere shown after an intensive clinical and analyticalinvestigation.Discussion: LCH is a disease with different organmanifestations whose diagnosis depends on histologicalfindings. We present a patient with isolatedconjunctival affectation, which to our knowledge isthe third case published in the literature(AU)

[Hemophagocytic syndrome secondary to visceral leishmaniasis]. / Síndrome hemofagocítico secundario a leishmaniasis visceral.

Haemophagocytic syndrome is a disease diagnosed according to clinical and analytical criteria, related to many infectious diseases. It is exceptionally described in patients infected with Leishmania. Visceral leishmaniasis is an uncommon disease in our country except in some areas where it is endemic. Its diagnosis is sometimes difficult and the use of other methods currently available is needed. Haemophagocytic syndrome treatment is based on established chemotherapy protocols, but when it is secondary to Visceral Leishmaniasis, it may be an exception, since the abnormalities can be resolved by treatment of the infection itself. This treatment has improved recently as Liposomal Amphotericin B has replaced classic antimonials, being more beneficial due to less adverse effects and a shorter treatment time.

Síndrome hemofagocítico secundario a leishmaniasis visceral / Hemophagocytic syndrome secondary to visceral leishmaniasis

El síndrome hemofagocítico es una enfermedad diagnosticada basándose en criterios clínicos y analíticos, relacionada con numerosas entidades infecciosas. De forma excepcional se ha descrito en pacientes infectados con el parásito Leishmania. La leishmaniasis visceral es una patología infrecuente en nuestro país, salvo en zonas concretas donde es endémica. Su diagnóstico en ocasiones es difícil y hay que recurrir a varios de los métodos actualmente disponibles. El tratamiento del síndrome hemofagocítico se fundamenta en pautas quimioterápicas protocolizadas, aunque puede representar una excepción cuando es secundario a la leishmaniasis visceral, ya que el tratamiento antiinfeccioso suele resolver las alteraciones por sí mismo. Dicha terapia ha evolucionado en los últimos tiempos al sustituir la anfotericina B liposomal a las pautas clásicas con antimoniales y logrando beneficios por sus menores efectos secundarios y por acortar el tiempo de tratamiento (AU)

Haemophagocytic syndrome is a disease diagnosed according to clinical and analytical criteria, related to many infectious diseases. It is exceptionally described in patients infected with Leishmania. Visceral leishmaniasis is an uncommon disease in our country except in some areas where it is endemic. Its diagnosis is sometimes difficult and the use of other methods currently available is needed. Haemophagocytic syndrome treatment is based on established chemotherapy protocols, but when it is secondary to Visceral Leishmaniasis, it may be an exception, since the abnormalities can be resolved by treatment of the infection itself. This treatment has improved recently as Liposomal Amphotericin B has replaced classic antimonials, being more beneficial due to less adverse effects and a shorter treatment time (AU)