Obstetric complications as a risk factor for first psychotic episodes in childhood and adolescence.

There are reports of significant association between obstetric complications (OC) and childhood psychosis. Authors conducted a case-control study of 102 children and adolescents with a first episode psychosis (FEP) and 94 healthy controls (HC), using the obstetric complications scale (OCS) and their medical records, to examine the risk of FPE. Patients were recruited from child and adolescent psychiatry units at six university hospitals and controls from publicly-funded schools of similar characteristics and from the same geographic areas. A logistic regression was performed to quantify the risk of psychosis in childhood and adolescence, based on OC, adjusting for potential confounding factors like socio economic status (SES) and family psychiatric history (FPH). OC appeared more frequently in the records of patients. Significant differences between patients and controls were found in Prenatal OC (15.7% vs. 5.3%, P < 0.05) and among them, bleeding in pregnancy showed the greatest difference between groups (12.7% vs. 2.1%, P < 0.01). In the logistic regression, bleeding in pregnancy showed a crude odds ratio (OR) of 6.7 (95%CI = 1.4-30.6) and 5.1 (CI 95% = 1.0-24.9) adjusted for SES and FPH. Therefore, bleeding in pregnancy is a likely risk factor for early-onset psychosis.

Contaminated feeding bottles: the source of an outbreak of Pseudomonas aeruginosa infections in a neonatal intensive care unit.

BACKGROUND: Outbreaks of Pseudomonas aeruginosa have been reported in relationship with contamination of staff fingernails, hands, water baths, hand lotions and others. To our knowledge, contamination of milk and feeding bottles as a source of an outbreak of P aeruginosa infections has not been reported. The incidence of P aeruginosa infection/colonization in our neonatal intensive care unit increased from 1.9 per 1000 patient-days in August 2004 to 8.8 per 1000 patient-days in September 2004. METHODS: Samples were collected including hand and body lotions, water from the incubator humidifying system, the health care worker hands, and the feeding bottle preparation room. Strains were epidemiologically characterized by pulsed-field gel electrophoresis of SpeI-digested genomic DNA. P aeruginosa was isolated from a total of 30 neonates during the period September 2004 to December 2004. RESULTS: All cultures (139) of hand and body lotions, water from the incubator humidifying system, and hands of health care personnel were negative. Nine out of 48 samples collected from the feeding bottle preparation room were positive for P aeruginosa (6 samples of in-house prepared milk and 3 samples of water from dishwashers). Pulsed-field gel electrophoresis with SpeI showed that the strains isolated from neonates and from environmental samples were identical. Discontinuation of in-house preparation of feeding bottles and incorporation of unidose milk bottles stopped the outbreak. CONCLUSION: The preparation and solution of milk from multidose powder preparation may be a source of P aeruginosa infections in a neonatal intensive care unit. The use of manufactured, nonmanipulated, unidose feeding bottles should be considered more adequate.

Postpyloric enteral nutrition in the critically ill child with shock: a prospective observational study.

BACKGROUND: Tolerance to enteral nutrition in the critically ill child with shock has not been studied. The purpose of the study was to analyze the characteristics of enteral nutrition and its tolerance in the critically ill child with shock and to compare this with non-shocked patients. METHODS: A prospective, observational study was performed including critically ill children with shock who received postpyloric enteral nutrition (PEN). The type of nutrition used, its duration, tolerance, and gastrointestinal complications were assessed. The 65 children with shock who received PEN were compared with 461 non-shocked critically ill children who received PEN. RESULTS: Sixty-five critically ill children with shock, aged between 21 days and 22 years, received PEN. 75.4% of patients with shock received PEN exclusively. The mean duration of the PEN was 25.2 days and the maximum calorie intake was 79.4 kcal/kg/day. Twenty patients with shock (30.7%) presented gastrointestinal complications, 10 (15.4%) abdominal distension and/or excessive gastric residue, 13 (20%) diarrhoea, 1 necrotising enterocolitis, and 1 duodenal perforation due to the postpyloric tube. The frequency of gastrointestinal complications was significantly higher than in the other 461 critically ill children (9.1%). PEN was suspended due to gastrointestinal complications in 6 patients with shock (9.2%). There were 18 deaths among the patients with shock and PEN (27.7%). In only one patient was the death related to complications of the nutrition. CONCLUSION: Although most critically ill children with shock can tolerate postpyloric enteral nutrition, the incidence of gastrointestinal complications is higher in this group of patients than in other critically ill children.

Encuestas de satisfacción al personal facultativo y de enfermería como método de mejora de la calidad de los procesos del servicio de farmacia / Questionnaires on medical and nursing staff satisfaction as a method of improving

Objetivo: Describir los resultados de una encuesta de satisfacción dirigida al personal facultativo y de enfermería como método de mejora de la calidad de los procesos, de acuerdo con la norma ISO 9001:2000. Método: Estudio transversal mediante cuestionario autoadministrado. Se calculó un tamaño muestral de 405 para enfermería y 337 para los facultativos, asumiendo un porcentaje general de satisfacción del 80%, con una precisión del 3,5% y un riesgo alfa de 0,05. Resultados: La tasa de respuesta fue del 46,4% entre el personal de enfermería y del 24,3% entre los facultativos. La satisfacción general fue favorable para el 80,3% de enfermería y para el 96,3% de los facultativos. El ítem mejor valorado por ambos grupos fue la amabilidad del farmacéutico. Lo peor valorado por enfermería fue el cumplimiento del horario pactado para dispensar los pedidos y por los facultativos, el horario de dispensación de la farmacia. Conclusiones: La satisfacción percibida por enfermería y facultativos es una de las fuentes de información útil para establecer acciones de mejora dentro de la acreditación según la norma ISO 9001:2000

Objective: To report the results of a survey directed at medical and nursing staff as a method of improving the quality of procedures, in accordance with standard ISO 9001:2000. Method: Cross-sectional study using a self-administered questionnaire. A sample size of 405 was calculated as 405, for nurses and 337 for medical staff, assuming an overall percentage of satisfaction of 80%, with a precision of 3.5% and an alpha risk of 0.05. Results: The response rate was 46.4% for nursing staff and 24.3% for medical personnel. The overall satisfaction was favourable in 80.3% of nurses and 96.3% of doctors. The best valued item by both groups was the friendliness of the pharmacist. The worst valued by nursing staff, was the compliance to the agreed opening times for dispensing orders, and for doctors, the pharmacy opening times. Conclusions: The perceived satisfaction by nursing and medical staff is one of the most useful sources of information for establi-shing improvement processes for accreditation in accordance with ISO 9001:2000

[Not Available]. / Encuestas de satisfacción al personal facultativo y de enfermería como método de mejora de la calidad de los procesos del servicio de farmacia.

OBJECTIVE: To report the results of a survey directed at medical and nursing staff as a method of improving the quality of procedures, in accordance with standard ISO 9001:2000. METHOD: Cross-sectional study using a self-administered questionnaire. A sample size of 405 was calculated as 405, for nurses and 337 for medical staff, assuming an overall percentage of satisfaction of 80%, with a precision of 3.5% and an alpha risk of 0.05. RESULTS: The response rate was 46.4% for nursing staff and 24.3% for medical personnel. The overall satisfaction was favourable in 80.3% of nurses and 96.3% of doctors. The best valued item by both groups was the friendliness of the pharmacist. The worst valued by nursing staff, was the compliance to the agreed opening times for dispensing orders, and for doctors, the pharmacy opening times. CONCLUSIONS: The perceived satisfaction by nursing and medical staff is one of the most useful sources of information for establishing improvement processes for accreditation in accordance with ISO 9001:2000.

[Importance of hepatology in the current Spanish health environment]. / Importancia de la hepatología en el entorno sanitario, español, actual.

OBJECTIVES: To find out the impact of hepatic diseases on care activity at national and autonomous region level, and in a tertiary hospital with a Hepatology Department. MATERIAL AND METHODS: An analysis was carried out on BMDS data (Basic Minimum Data Set) from 1999 to 2003. In the study of cases from the Gregorio Marañón Hospital, Madrid, data bases from the years 2000-2004 were used, and indicators were calculated, such as the percentages of digestive diseases of the total hospital discharges, of digestive diseases that were admitted into the Digestive Diseases Department, and of the total discharges form this Department that originated from hepatic diseases. RESULTS: Hepatic diseases represented around 23% of the hospital discharges generated by gastroenterology at national level and about the same at autonomous regional level. Hepatocellular carcinoma shows a slow and sustained increase, reaching 22.7% of discharges, due to hepatic disease, in 2003. The mortality specifically due to hepatic disease was around 12% in the year 2003. In the study carried out in a tertiary hospital, 21.2% of the total hospital discharges were due to digestive diseases, in the last year analysed. Only 12.48% of these had been admitted to the Digestive Diseases Department and more than 50% were attributed to Hepatology. CONCLUSIONS: Hepatology is a very important area of health care within Gastroenterology, showing a sustained growth in the last few years.

Importancia de la hepatología en el entorno sanitario, español, actual / Importance of hepatology in the current Spanish health environment

Objetivos: Conocer el impacto que las enfermedades hepáticas tienen sobre la actividad asistencial en los ámbitos nacional y autonómico, y en un hospital de tercer nivel con sección de hepatología. Material y métodos: Se ha procedido al análisis de los datos del Conjunto Mínimo Básico de Datos (CMBD) desde 1999 hasta 2003. En el estudio de los casos pertenecientes al Hospital Gregorio Marañón se han utilizado las bases de datos de los años 2000-2004, y se han calculado ciertos indicadores, como el porcentaje de casos de enfermedades digestivas sobre el total de altas hospitalarias, de los pacientes con enfermedades digestivas ingresados en el servicio de aparato digestivo, y sobre el total de altas de dicho servicio las que proceden de enfermedades hepáticas. Resultados: Las enfermedades hepáticas representan alrededor del 23% de las altas producidas en los servicios de gastroenterología a nivel nacional y de forma similar a nivel autonómico. El hepatocarcinoma presenta un incremento lento y sostenido que alcanza el 22,7% de las altas por enfermedades hepáticas en el año 2003. La tasa de mortalidad específica por enfermedades hepáticas se sitúa en el 12% en el año 2003. En el estudio realizado en un hospital de tercer nivel, durante el último año analizado, el 21,2% del total de las altas hospitalarias se debe a una enfermedad digestiva; de estos pacientes, había ingresado en el servicio de aparato digestivo sólo el 12,48%. De las altas del servicio de aparato digestivo, más del 50% se atribuye al área de hepatología. Conclusiones: La hepatología representa un área de atención asistencial de gran importancia dentro de la gastroenterología, y ha presentado un crecimiento sostenido en los últimos años

Objectives: To find out the impact of hepatic diseases on care activity at national and autonomous region level, and in a tertiary hospital with a Hepatology Department. Material and methods: An anlaysis was carried out on BMDS data (Basic Minimum Data Set) from 1999 to 2003. In the study of cases from the Gregorio Marañón Hospital, Madrid, data bases from the years 2000-2004 were used, and indicators were calculated, such as the percentages of digestive diseases of the total hospital discharges, of digestive diseases that were admitted into the Digestive Diseases Department, and of the total discharges form this Department that originated from hepatic diseases. Results: Hepatic diseases represented around 23% of the hospital discharges generated by gastroenterology at national level and about the same at autonomous regional level. Hepatocellular carcinoma shows a slow and sustained increase, reaching 22.7% of discharges, due to hepatic disease, in 2003. The mortality specifically due to hepatic disease was around 12% in the year 2003. In the study carried out in a tertiary hospital, 21.2% of the total hospital discharges were due to digestive diseases, in the last year analysed. Only 12.48% of these had been admitted to the Digestive Diseases Department and more than 50% were attributed to Hepatology. Conclusions: Hepatology is a very important area of health care within Gastroenterology, showing a sustained growth in the last few years

Early transpyloric enteral nutrition in critically ill children.

OBJECTIVE: We compared the tolerance of early (within the first 24 h after admission to the pediatric intensive care unit) and late transpyloric enteral nutrition in critically ill children. METHODS: We performed a prospective observational study including all critically ill children fed using transpyloric enteral nutrition. The clinical characteristics, energy intake, tolerance, and complications of nutritional delivery between the children with early (first 24 h) and late (after 24 h, range 1-43 d) transpyloric enteral nutrition were compared. RESULTS: Transpyloric nutrition was started within the first 24 h in 202 (38.5%) of the 526 children. There were no differences in the diagnoses, incidence of organ disturbances, doses of vasoactive drugs, or mortality between the two groups. There were no differences in the maximum number of calories delivered or in the duration of the nutrition between children with early and late transpyloric nutrition. The incidence of abdominal distention was lower in the children receiving early transpyloric nutrition (3.5%) than in those receiving nutrition at a later date (7.8%; P < 0.05). Moreover, 6.3% of patients presented diarrhea, with no difference being found between the two groups. CONCLUSION: Early transpyloric enteral nutrition is well tolerated in critically ill children and is not associated with an increase in incidence of complications.

Transpyloric enteral nutrition in the critically ill child with renal failure.

OBJECTIVE: To study the efficacy and tolerance of transpyloric enteral nutrition (TEN) in the critically ill child with acute renal failure (ARF). DESIGN: Prospective observational study. SETTING: Paediatric intensive care unit. PATIENTS: Critically ill children with ARF who received TEN were included in the study. They were compared with the remaining 473 critically ill children receiving TEN in this period. Tolerance of nutrition and gastrointestinal complications were assessed. INTERVENTION: Transpyloric enteral nutrition. MEASUREMENTS AND RESULTS: Fifty-three critically ill children with ARF aged between 3 days and 17 years received TEN. Children with ARF more frequently received parenteral nutrition before TEN (56.6%) than the other patients (17.5%). The incidence of shock, hepatic alterations and mortality was significantly higher in patients with ARF than in the remaining children. In children with ARF the mean duration of the TEN was 16.5-27.3 days and the maximum caloric intake was 77-26.7 kcal/kg/day. Thirteen patients (24.5%) presented gastrointestinal complications, 9 (17%) abdominal distension and/or excessive gastric residue, 5 (9.4%) diarrhoea, 1 necrotising enterocolitis and 1 duodenal perforation. The frequency of gastrointestinal complications was significantly higher in children with ARF. TEN was definitive suspended in five patients due to gastrointestinal complications. Four of these patients were treated with continuous renal replacement therapy. Thirty percent of patients died during TEN. In only one patient was the death related to complications of the nutrition. CONCLUSIONS: Critically ill children with ARF tolerate TEN, although the incidence of gastrointestinal complications is higher than in other critically ill children.

Transpyloric enteral feeding in the postoperative of cardiac surgery in children.

PURPOSE: The aim of this study is to assess the utility of transpyloric enteral nutrition in the postoperative period of cardiac surgery in children. METHODS: A prospective, observational study was performed on children receiving transpyloric enteral nutrition in the postoperative period of cardiac surgery. The type of nutrition, duration, tolerance, and complications were studied. RESULTS: Children (212) between the ages of 3 days and 17 years received transpyloric enteral nutrition in the postoperative period of cardiac surgery. The duration of the transpyloric feeding was 16 +/- 23.8 days, and the maximum calorie delivery was 85.1 +/- 25.7 kcal/kg/d. Tolerance to nutrition was good and was not affected by the infusion of vasoactive drugs, sedatives, or muscle relaxants. Of the study population, 14.6% presented with gastrointestinal complications, 9.4% with abdominal distension and/or excessive gastric residue, and 7.5% with diarrhea. Nutrition was withdrawn in 2.4% of the patients because of gastrointestinal complications. Mortality was not related to any characteristic of the nutrition or to gastrointestinal complications. CONCLUSIONS: Transpyloric enteral nutrition is useful and is a simple feeding method that enables a high calorie delivery to be provided with few complications in the postoperative period of cardiac surgery in children, including those receiving high doses of sedatives and muscle relaxants.

Circulating dendritic cells subsets and regulatory T-cells at multiple sclerosis relapse: differential short-term changes on corticosteroids therapy.

Glucocorticoids remain the treatment of choice for MS relapses. However, little is known on the effect of intravenous methylprednisolone (IVMP) on dendritic cells (DCs) and regulatory T-cells (TReg). Our main goal was to quantify circulating myeloid and plasmacytoid DCs (mDCs and pDCs), and TReg at MS relapse versus healthy controls; and to analyse the short-term changes after IVMP for MS relapse. MS patients at relapse compared to controls showed higher %CD4+CD25high+ TReg (p<0.01). After 5-days of IVMP, activated T-lymphocytes (p=0.001), pDCs (p<0.0001), and CD11c+ mDCs (p<0.0001) decreased. By contrast, CD4+CD25+ and CD4+CD25high+ TReg further increased (p<0.0001 both). Changes on these subsets may play a relevant role in the immunosuppressive activity of this drug.

Continuous venovenous renal replacement therapy using a pulsatile blood pump.

The objective of this study was to evaluate the efficacy of a pulsatile pump for continuous renal replacement therapy in a pediatric-size animal model. A vacuum-driven, tubular, blood-pumping device was used in 13 pigs weighing 10.4+/-1.5 kg, connected to a neonatal hemofiltration circuit with an FH22 filter and a flow sensor. Three different flow rates [30 ml/min (8 cases), 15 ml/min (3 cases), and 5 ml/min (2 cases] were used over 2-h periods. Aspiration pressure, frequency of pulsation, blood flow rate, ultrafiltrate volume, pre- and post-filter pressures, heart rate, arterial blood pressure, temperature, pH, sodium, potassium, chloride, urea, creatinine, glucose, and hematocrit were measured at 30-min intervals. The mean ultrafiltrate flow was 0.54+/-0.33 ml/kg per min. The aspiration pressure and pulsation frequency needed to maintain blood flow remained stable throughout the experiment. There were no complications secondary to the use of this technique and no significant changes in heart rate, blood pressure, or analytical determinations. In conclusion, in this animal model, the pulsatile pump has been shown to be an effective method for continuous venovenous renal replacement therapy.