Efecto de la pandemia COVID en las urgencias traumatológicas pediátricas en tres zonas de España con distinta incidencia / Effect of the COVID pandemic on pediatric trauma emergencies in three areas of Spain with different incidence

Introducción y objetivos: Aunque se ha publicado mucho sobre el efecto de la pandemia en las urgencias traumatológicas, no se ha analizado si la incidencia de la infección o la distinta organización de los recursos disponibles según la comunidad autónoma fueron factores influyentes. Presentamos un estudio multicéntrico de tres hospitales terciarios de tres ciudades españolas con distintas características para estudiar cómo estos factores influyeron a las urgencias traumatológicas pediátricas durante la primera ola de la pandemia. Material y métodos: Presentamos un estudio retrospectivo de cohortes que compara y analiza las urgencias traumatológicas pediátricas en tres hospitales distintos durante el periodo de la primera ola de la pandemia COVID-19 y comparamos sus resultados con los del mismo periodo del año anterior, analizando el número de urgencias, la gravedad de la patología, la edad media de los pacientes, los días de ingreso y el tiempo de espera de los casos que requirieron tratamiento quirúrgico. Resultados: Se han analizado 6.474 episodios de urgencias traumatológicas infantiles. Se produjo una drástica reducción de la actividad en los tres hospitales, pero en distinta cuantía: del 83,5% en el hospital localizado en Madrid, del 75% en el hospital localizado en Valencia y del 65,9% en el ubicado en Palma de Mallorca. Las urgencias atendidas fueron de mayor gravedad en el año 2020 en comparación con el año 2019. La edad media de los pacientes atendidos durante la pandemia fue menor en comparación con el año anterior. No hubo diferencias en los días de ingreso, pero sí en la demora de la cirugía de las fracturas quirúrgicas. Conclusiones: La repercusión de la primera ola de la pandemia COVID-19 y el confinamiento decretado tuvieron una repercusión distinta en las urgencias traumatológicas pediátricas en los distintos hospitales según la incidencia de la infección y las medidas adoptadas en las diferentes comunidades autónomas.(AU)

Introduction and objectives: Although much has been published on the effect of the pandemic on trauma emergencies, it has not been analyzed whether the incidence of infection or different organization of available resources according to the Spanish region were influential factors. We present a multicenter study of three tertiary hospitals in three Spanish cities with different characteristics to study how these factors influenced pediatric trauma emergencies during the first wave of the pandemic. Material and methods: We present a retrospective cohort study that compares and analyzes pediatric trauma emergencies in three different hospitals during the period of the first wave of the COVID-19 pandemic and we compare them with the same period of the previous year, analyzing the number of emergencies, the severity of the pathology, the average age of the patients, the days of admission and the waiting time of the cases that required surgical treatment. Results: A total of 6,474 pediatric trauma emergency episodes have been analyzed. There was a drastic reduction in activity in the three hospitals, but in different amounts: 83.5% in the hospital located in Madrid, 75% in the hospital located in Valencia and 65.9% in the one located in Palma, Majorca. The emergencies attended were more serious in 2020 compared to 2019. The average age of patients treated during the pandemic was lower compared to the previous year. There were no differences in the days of admission, but there were differences in the delay in surgery for surgical fractures. Conclusions: The impact of the first wave of the COVID-19 pandemic and the decreed confinement had a different impact on pediatric trauma emergencies in the different hospitals according to the incidence of infection and the measures adopted in the different regions.(AU)

[Translated article] Effect of the COVID pandemic on paediatric trauma emergencies in three areas of Spain with different incidence / Efecto de la pandemia COVID en las urgencias traumatológicas pediátricas en 3 zonas de España con distinta incidencia

ntroducción y objetivos: Aunque se ha publicado mucho sobre el efecto de la pandemia en las urgencias traumatológicas, no se ha analizado si la incidencia de la infección o la distinta organización de los recursos disponibles según la comunidad autónoma fueron factores influyentes. Presentamos un estudio multicéntrico de tres hospitales terciarios de tres ciudades españolas con distintas características para estudiar cómo estos factores influyeron a las urgencias traumatológicas pediátricas durante la primera ola de la pandemia. Material y métodos: Presentamos un estudio retrospectivo de cohortes que compara y analiza las urgencias traumatológicas pediátricas en tres hospitales distintos durante el periodo de la primera ola de la pandemia COVID-19 y comparamos sus resultados con los del mismo periodo del año anterior, analizando el número de urgencias, la gravedad de la patología, la edad media de los pacientes, los días de ingreso y el tiempo de espera de los casos que requirieron tratamiento quirúrgico. Resultados: Se han analizado 6.474 episodios de urgencias traumatológicas infantiles. Se produjo una drástica reducción de la actividad en los tres hospitales, pero en distinta cuantía: del 83,5% en el hospital localizado en Madrid, del 75% en el hospital localizado en Valencia y del 65,9% en el ubicado en Palma de Mallorca. Las urgencias atendidas fueron de mayor gravedad en el año 2020 en comparación con el año 2019. La edad media de los pacientes atendidos durante la pandemia fue menor en comparación con el año anterior. No hubo diferencias en los días de ingreso, pero sí en la demora de la cirugía de las fracturas quirúrgicas. Conclusiones: La repercusión de la primera ola de la pandemia COVID-19 y el confinamiento decretado tuvieron una repercusión distinta en las urgencias traumatológicas pediátricas en los distintos hospitales según la incidencia de la infección y las medidas adoptadas en las diferentes comunidades autónomas.(AU)

Introduction and objectives: Although much has been published on the effect of the pandemic on trauma emergencies, it has not been analyzed whether the incidence of infection or different organization of available resources according to the Spanish region were influential factors. We present a multicenter study of three tertiary hospitals in three Spanish cities with different characteristics to study how these factors influenced pediatric trauma emergencies during the first wave of the pandemic. Material and methods: We present a retrospective cohort study that compares and analyzes pediatric trauma emergencies in three different hospitals during the period of the first wave of the COVID-19 pandemic and we compare them with the same period of the previous year, analyzing the number of emergencies, the severity of the pathology, the average age of the patients, the days of admission and the waiting time of the cases that required surgical treatment. Results: A total of 6,474 pediatric trauma emergency episodes have been analyzed. There was a drastic reduction in activity in the three hospitals, but in different amounts: 83.5% in the hospital located in Madrid, 75% in the hospital located in Valencia and 65.9% in the one located in Palma, Majorca. The emergencies attended were more serious in 2020 compared to 2019. The average age of patients treated during the pandemic was lower compared to the previous year. There were no differences in the days of admission, but there were differences in the delay in surgery for surgical fractures. Conclusions: The impact of the first wave of the COVID-19 pandemic and the decreed confinement had a different impact on pediatric trauma emergencies in the different hospitals according to the incidence of infection and the measures adopted in the different regions.(AU)

[Translated article] Effect of the COVID pandemic on paediatric trauma emergencies in three areas of Spain with different incidence.

INTRODUCTION AND OBJECTIVES: Although much has been published on the effect of the pandemic on trauma emergencies, it has not been analysed whether the incidence of infection or different organisation of available resources according to the Spanish region were influential factors. We present a multicenter study of three tertiary hospitals in three Spanish cities with different characteristics to study how these factors influenced paediatric trauma emergencies during the first wave of the pandemic. MATERIAL AND METHODS: We present a retrospective cohort study that compares and analyzes paediatric trauma emergencies in three different hospitals during the period of the first wave of the COVID-19 pandemic and we compare them with the same period of the previous year, analyzing the number of emergencies, the severity of the pathology, the average age of the patients, the days of admission and the waiting time of the cases that required surgical treatment. RESULTS: A total of 6474 paediatric trauma emergency episodes have been analysed. There was a drastic reduction in activity in the three hospitals, but in different amounts: 83.5% in the hospital located in Madrid, 75% in the hospital located in Valencia and 65.9% in the one located in Palma, Majorca. The emergencies attended were more serious in 2020 compared to 2019. The average age of patients treated during the pandemic was lower compared to the previous year. There were no differences in the days of admission, but there were differences in the delay in surgery for surgical fractures. CONCLUSIONS: The impact of the first wave of the COVID-19 pandemic and the decreed confinement had a different impact on paediatric trauma emergencies in the different hospitals according to the incidence of infection and the measures adopted in the different regions. In all cases there was a significant reduction in activity, a greater proportion of medium and severe pathologies were attended to, the average age of the patients attended was lower and a delay was observed in surgeries performed in the emergency room, probably due to the need to request a PCR test to detect a COVID-19 infection.

Effect of the COVID pandemic on pediatric trauma emergencies in three areas of Spain with different incidence. / Efecto de la pandemia COVID en las urgencias traumatológicas pediátricas en tres zonas de España con distinta incidencia.

INTRODUCTION AND OBJECTIVES: Although much has been published on the effect of the pandemic on trauma emergencies, it has not been analyzed whether the incidence of infection or different organization of available resources according to the Spanish region were influential factors. We present a multicenter study of three tertiary hospitals in three Spanish cities with different characteristics to study how these factors influenced pediatric trauma emergencies during the first wave of the pandemic. MATERIAL AND METHODS: We present a retrospective cohort study that compares and analyzes pediatric trauma emergencies in three different hospitals during the period of the first wave of the COVID-19 pandemic and we compare them with the same period of the previous year, analyzing the number of emergencies, the severity of the pathology, the average age of the patients, the days of admission and the waiting time of the cases that required surgical treatment. RESULTS: A total of 6,474 pediatric trauma emergency episodes have been analyzed. There was a drastic reduction in activity in the three hospitals, but in different amounts: 83.5% in the hospital located in Madrid, 75% in the hospital located in Valencia and 65.9% in the one located in Palma, Majorca. The emergencies attended were more serious in 2020 compared to 2019. The average age of patients treated during the pandemic was lower compared to the previous year. There were no differences in the days of admission, but there were differences in the delay in surgery for surgical fractures. CONCLUSIONS: The impact of the first wave of the COVID-19 pandemic and the decreed confinement had a different impact on pediatric trauma emergencies in the different hospitals according to the incidence of infection and the measures adopted in the different regions. In all cases there was a significant reduction in activity, a greater proportion of medium and severe pathologies were attended to, the average age of the patients attended was lower and a delay was observed in surgeries performed in the emergency room, probably due to the need to request a PCR test to detect a COVID-19 infection.

Tratamiento quirúrgico protocolizado de las tríadas terribles de codo. Resultados y complicaciones / Protocolised surgical treatment of terrible triad of elbow. Results and complications

Introducción: La tríada terrible de codo es una enfermedad asociada a altas tasas de complicaciones, por ello queremos estudiar los resultados y las complicaciones. Material y métodos: Se ha utilizado la base de datos de nuestro hospital durante 2005-2015, recogiendo características del paciente, de la fractura, de la cirugía y las complicaciones asociadas, así como resultados funcionales y rango de movilidad. Resultados: Se obtuvieron un total de 62 tríadas, de las cuales 27 (43%) eran mujeres y 35 (56%) eran hombres. A todos se les realizó un abordaje lateral de Kaplan y en aquellos que lo necesitaron se complementó con un abordaje medial para reparar el LCM. La cabeza radial se sintetizó en 14 (22%) casos, se colocó una prótesis en 45 (74%) de casos y otras actuaciones en 3 (5%) casos. La osteosíntesis de la apófisis coroides se realizó mediante arpón+/-sutura transósea en 41 (62%) pacientes y mediante síntesis en 12 (19%) casos. En 9 (14%) casos no se realizó ninguna actuación. En el 100% de los casos se reparó el LCL y en 9 (14%) hubo que reparar también el LCM. Un 22% de los pacientes precisaron FE por inestabilidad tras la técnica quirúrgica. Respecto a resultados, se obtuvo un rango de movilidad de entre 120°/-20° de flexoextensión y 98°/85° de pronosupinación. En cuanto a complicaciones, obtuvimos un total de 17 (27%). Conclusiones: Las tríadas de codo son lesiones osteoligamentosas complejas donde es necesario realizar una cirugía protocolizada, a pesar de lo cual, existen un 27% de complicaciones

Background: Terrible triad of elbow is a complex lesion with a high rate of complications. Our goal is to analyse both clinical results and complications after performing protocolised surgery. Material and methods: The database of our hospital was used during 2005-2015, collecting characteristics of the patient, the fracture, the surgery and the associated complications, as well as functional results and range of mobility. Results: A total of 62 triads were obtained, of which 27 (43%) were women and 35 (56%) were men. All had a Kaplan lateral approach and those who needed it were complemented with a medial approach to repair the LCM. The radial head was synthesized in 14 (22%) cases, a prosthesis was placed in 45 (74%) cases and other actions in 3 (5%) cases. Osteosynthesis of the choroid process was performed by transosseous harpoon+/-suture in 41 (62%) patients and by synthesis in 12 (19%) cases. In 9 (14%) cases, no action was taken. In 100% of the cases the LCL was repaired and in 9 (14%) the LCM also had to be repaired. Twenty-two percent of the patients required ESA due to instability after the surgical technique. With respect to results, a range of mobility was obtained between 120°/-20° of flexoextension and 98°/85° of pronosupination. In terms of complications, we obtained a total of 17 (27%). Conclusions: Elbow triads are complex lesions where protocolised surgery is necessary, nevertheless the complication rate was 27% in our series

Protocolised surgical treatment of terrible triad of elbow. Results and complications. / Tratamiento quirúrgico protocolizado de las tríadas terribles de codo. Resultados y complicaciones.

BACKGROUND: Terrible triad of elbow is a complex lesion with a high rate of complications. Our goal is to analyse both clinical results and complications after performing protocolised surgery. MATERIAL AND METHODS: The database of our hospital was used during 2005-2015, collecting characteristics of the patient, the fracture, the surgery and the associated complications, as well as functional results and range of mobility. RESULTS: A total of 62 triads were obtained, of which 27 (43%) were women and 35 (56%) were men. All had a Kaplan lateral approach and those who needed it were complemented with a medial approach to repair the LCM. The radial head was synthesized in 14 (22%) cases, a prosthesis was placed in 45 (74%) cases and other actions in 3 (5%) cases. Osteosynthesis of the choroid process was performed by transosseous harpoon±suture in 41 (62%) patients and by synthesis in 12 (19%) cases. In 9 (14%) cases, no action was taken. In 100% of the cases the LCL was repaired and in 9 (14%) the LCM also had to be repaired. Twenty-two percent of the patients required ESA due to instability after the surgical technique. With respect to results, a range of mobility was obtained between 120°/-20° of flexoextension and 98°/85° of pronosupination. In terms of complications, we obtained a total of 17 (27%). CONCLUSIONS: Elbow triads are complex lesions where protocolised surgery is necessary, nevertheless the complication rate was 27% in our series.

Hepatitis C virus RNA (HCV-RNA) in blood donors and family members seropositive for anti-HCV antibodies.

BACKGROUND: Non-A, non-B virus is responsible for 75-90% of all cases of blood transfusion-related hepatitis. The aim of this work was to determine hepatitis C virus RNA (HCV-RNA) in a group of blood donors and their household contacts. Serotype and genotype of the isolates were also studied. METHODS: HCV antibodies were investigated in 44,588 blood donors with a commercial immunoassay. Forty-four seropositive donors and 72 household members were further studied. Quantitative analysis of viral RNA was performed with Amplicor HCV 2.0 test, while genotype was determined by INNO-LiPA test and serotype with Murex HCV test. RESULTS: Among the 44,588 donors studied, 333 (0.74%) were positive for anti-HCV. Viral RNA was found in 35 (80%) of the 44 seropositive cases studied. Among the 72 household members, HCV antibodies were detected in six (8.3%) and HCV-RNA in four of these individuals. Serotype 1 and genotype 1 were the most frequent types detected (48 and 64%, respectively). The genotype in the blood donor matched that of his seropositive family member in four of six cases. CONCLUSIONS: Our results suggest that intrafamilial transmission of HCV may occur and we stress the need to study household members of seropositive blood donors, as they have a high risk of infection. In this community, genotype 1 is the most prevalent type in blood donors and family members.

[Barrier family planning methods as risk factor which predisposes to preeclampsia]. / Los métodos de planificación familiar de barrera como factor de riesgo que predispone a la presencia de preeclampsia.

Preeclampsia is a pregnancy-specific syndrome, it occurs in approximately 5-10% of all pregnancies and the etiology remains unknown, but the primigravida adolescent as such as multigravid older women whom have conceived with a new sexual partner have a greater risk, this has been associated also with the use of barrier contraceptive methods that prevent exposure to sperm with the endometrial cavity. An immunological factor has been suspected because fetal antigen's could cause antigenic reaction with the maternal immunological apparatus, for first exposure at these antigens, since the fetus is considered like an allotransplantation. This is supported in some studies that report that the use of condoms, spermicides and withdrawal are associated with developing of preeclampsia in subsequent pregnancy, and another hand indicate at cohabitation preceded for long period, practiced oral sex and use of contraceptive methods that permit exposure to sperm viable with uterus decreased the prevalence of preeclampsia. To test this hypothesis, we initially used data from two groups of pregnant women, comparing the contraceptive and reproductive history of 73 pregnant women with preeclampsia and 70 pregnant women without preeclampsia. The odds ratio for preeclampsia indicated a 2.52-fold (with 95% confidence interval, 1.17 to 5.44, p < 0.05), increased risk of preeclampsia for users of barrier contraceptives compared with women using nonbarrier contraceptives methods. Other variables like socio-demographic and obstetrics analysis were not different between both groups. This study suggest that nonbarrier contraceptive methods or the exposure of paternal spermatic antigens is protective against development of preeclampsia. Further immunological studies are necessary to determine the role of contraception methods and preeclampsia.

Live varicella vaccine in both immunocompromised and healthy children.

BACKGROUND: There is no information on the use of live varicella vaccine in Mexican children. Our objective was to evaluate antibody response and safety of the live varicella vaccine in both healthy and immunocompromised Mexican children. METHODS: One hundred children with no history of varicella/zoster were vaccinated with a live attenuated varicella vaccine. According to their immune status, patients were divided into either a compromised (leukemia, solid tumors, chronic renal failure, and cirrhosis) or a healthy children group. Serum IgG antibodies against VZV were measured by ELISA at baseline and at 3 and 6 months after vaccination. RESULTS: A positive VZV-ELISA at baseline was detected in 36 of 67 (53.7%) immunocompromised children and in 22 of 33 (66%) healthy children. Among VZV-seronegative children, seroconversion at 6 months post-vaccination was observed in 90.3% of compromised children and in 100% of healthy children. Increases in serum antibody levels at 3 and 6 months post-vaccination was similar in both groups. VZV vaccine-related adverse reactions, mostly mild and local, were detected in 29% of the children. Three compromised children had a mild rash symptomatic of varicella after vaccination. CONCLUSIONS: About 50% of immunosuppressed children (mean age 8.8 +/- 3.6 years) with no varicella history were VZV-seronegative. Almost all of these compromised VZV-seronegative patients seroconverted 6 months after vaccine. In addition, antibody titers were similar in both compromised and healthy children.

Seroepidemiology of hepatitis E virus infection in Mexican subjects 1 to 29 years of age.

BACKGROUND: Hepatitis E virus (HEV) infection causes an acute, self-limited hepatitis associated with high mortality in pregnant women. Community-based surveys are scarce and information on HEV infection in populations is needed. The aim of this work was to study seroprevalence to HEV in young adults and children in Mexico, using a community-based survey. METHODS: Serum samples from 3,549 individuals were studied; the population included subjects from 1 to 29 years old from all regions of the country representing all socioeconomic levels. IgG anti-HEV was determined by ELISA. RESULTS: Anti-HEV antibodies were found in 374 (10.5%) individuals. Seroprevalence increased with age from 1.1% in children younger than 5 years to 14.2% in persons 26 to 29 years of age (p = 0.006). Risk factors for infection included living in rural communities and a low educational level. Seroprevalence was not associated with the level of regional development. CONCLUSIONS: HEV infection is endemic in Mexico. Age, type of community, and educational level were identified as risk factors for infection.

[Janiceps cephalo-thoraco-abdominopagus pregnancy]. / Embarazo Janiceps, cefalotoracoabdominopago.

Cojoined twins was analyzed type cephalothoracoabdominopagus, is especially rare case of dysgenetic abnormalities, in which the heads, necs, thoraces and abdomen are joined. Twins births joined have been said to occur with a frequency of 1 per 100,000 deliveries, but the incidence of this malformations is one in three million conjoined twins. Conjoined twinning may be associated with a more fundamental failure of embryonic migration or may be associated with a more fundamental failure of ambryonic migration or fusion, 95% of conjoined twins are females. The Janiceps type of cephalothoracoabdominopagus derives its name from Janus, in Roman nythology, the god of doors and gateways, his statue with two faces, facing east and west for the beginning and ending of the day. The anatomic features with the Janiceps type of cephalothoracoabdominopagus are describe, and the mechanisms that may have played a role in the abnormal development of these twins are discussed. The mother was a 22-year-old, with last menstrual period January 12, 1997. She came to the other medical center, with an ultrasound study performed at 27 weeks' gestation, and possible multiple fetal anormalies, a second ultrasound examination, confirmed abnormalities, two hearts, as well as polihidramnios. Past history included normal espontaneous vaginal delivery of healthy term infant, who were alive and well, family history was negative for congenital anormalies, and no prior history of twinning. She denied use of drugs, alcohol, or cigarettes; had no fever, vaginal bleeding, or other problems with the pregnancy. The abdomen was gravid to 48 cm, and contractions were palpable, fetal heart tones were 1400 beats per minute. On the one day of admission the patient underwent delivery of conjoined infants, the Apgar scores were zero at 1 minute and at 5 minutes. The infants were joined front-to-front, with two faces, each a compositive of toth twins, each twin han four extremities, in each face resambled a one nose, with structure incomplete in one face, esophagi were fused. Each twin had its own skeletal system extending from the cervical spine downwards. The congenital malformations for each conjoined twin are listed in the autopsy report, abnormalities included absent ovary and uterus in both twin. COnjoined twins develop from a single zygote, the cause is unknown. We proposed, embryonic tissue divides incompletely, likely to result in twinning anomalies from the 15th to 16th day postovulation, during the late part of period six, about the third week.

Infection of pregnant women with hepatitis B and C viruses and risks for vertical transmission.

Pregnant women infected with hepatitis B and C viruses pose a risk for infecting their newborn infants by vertical transmission. We studied 6,253 pregnant women aged 12-49 years for infection with hepatitis B (HBV) and C (HCV) viruses. Infection was diagnosed by measuring IgG antibodies against HBc, HBs, HBe, as well as IgM-HBc and HCV viral antigens with commercially available immunoassay kits. HBV infection was detected in 113 cases (1.8%), and prevalence was significantly higher (2.4%) in a group of women with a high-risk pregnancy who were attending a perinatology hospital than in healthy pregnant women (1.67%, p < 0.05). Infection with HBV was significantly higher in women older than 30 years old (p < 0.05). HBsAg was found in blood, colostrum and vaginal exudate of two pregnant women; HBsAg was detected in the gastric aspirate but not in the blood of the two newborn infants. HBeAg and IgM-HBc were not detected in any of the samples. DNA-HBV was detected in serum of seven women, and DNA-HBV was detected in the gastric aspirate of only one of the newborns. HCV infection was diagnosed in three out of 111 women with markers for HBV infection (2.7%), and in 6 out of 1,000 women without these markers (0.6%). Anti-HCV antibodies were found in the serum of six of their infants during up to six months of age. Infants were monitored for one year and none of them developed any sign of hepatic disease. These results suggest that special attention should be paid to women older than 30 years and with a high-risk pregnancy, as they are at a higher risk of HBV and HCV infections.

Comparison of five methods for the detection of measles specific immunoglobulin G antibody.

In this work we compare the sensitivity, specificity and predictive values of hemagglutination inhibition (HI), immunofluorescent assay (IFA), biotin-streptavidin immunofluorescent assay (B/SA-IFA), enzyme-linked immunosorbent assay (EIA) and plaque neutralization test (PN). This study includes serum samples from children taken before and after vaccination, children with clinically diagnosed measles and household contacts. EIA were the most specific and better serological diagnostic test. HI and IFA had high sensitivity but low specificity. An alternative to EIA is B/SAIFA, which is cheaper than EIA and can be used in the study of small outbreaks or in isolated cases.

[Prevalence of rubella virus antibodies in pregnant women in two zones of Valle de Mexico]. / Prevalencia de anticuerpos para el virus de rubéola en mujeres gestantes de dos zonas del Valle de México.

The aim of this study was to determine the prevalence of specific antibodies against rubella virus in pregnant women from Iztapalapa and Nezahualcóyotl areas of the valley of Mexico, in order to evaluate susceptibility to this virus in these areas. Serum samples collected from 5535 women between 15 and 44 years old were studied by the hemaglutination inhibition test. 92.6% of positivity was obtained and no significant difference was observed between different age groups. The prevalence of rubella antibodies in pregnant women was 92.4% for Iztapalapa zone and 92.8% for Nezahualcóyotl. The titles of antibodies against rubella virus more frecuently presented were 1:16 (36.3%) and 1:32 (29.6%). The data obtained in this study suggest that women attending Medical Services of the Mexican Institute of Social Segurity in reproductive age from the Iztapalapa and Nezahualcóyotl areas, do not need massive vaccination against rubella virus.

[Protection of health personnel against hepatitis B by DNA recombinant vaccine]. / Protección contra hepatitis B en trabajadores de salud con vacuna de DNA recombinante.

Hepatitis B (HVB) is a worldwide spread health problem. It has been assessed that there are more than 300 millions of carriers. HVB has a special concern for health care workers (HCW's) due to the high risk among them of getting the infection in clinic-setting areas. According to some estimation, the risk for hepatitis B among HCW's is 2 to 10 times higher than the risk for general population. The risk is related to the degree of direct contact with blood and body fluids, as well as, with the frequency of traumatic exposure in the work place. The control of this infection is based on the observance of universal precautions and the vaccination, since there is not treatment against this disease. The results of an efficacy-evaluation of DNA recombinant vaccine against hepatitis B are reported; 174 HCW's were studied; three dosages of vaccine were administered (0.1st and 6th month) by I.M. via. In addition, three serum samples were collected at 0, 1st and 9th month after vaccine administration. We did not find carriers of surface antigen of hepatitis B. With regards to seroconverted individuals we observed the following results: there were a satisfactory response to the vaccine in 163 individuals (93.7%); however, 8 (4.6%) persons did not reach titles of protective antibodies and 3 (1.7%) did not show seroconversion at all. Therefore, 11 persons (6.3% of the total) did not result immunized. The secondary reactions to the vaccines were low in frequency and mainly of local presentation. Among the study population we did not find chronic carries of hepatitis B.(ABSTRACT TRUNCATED AT 250 WORDS)

[Hepatitis B and delta: the prevalence of seroepidemiological markers in volunteer blood donors and their families]. / Hepatitis B y delta: prevalencia de marcadores seroepidemiológicos en donadores de sangre voluntarios y su grupo familiar.

41 volunteer blood donors and his relatives were studied in order to know about the prevalence of hepatitis B and D virus infections in selected groups. Frequency of HBsAg+ carriers was 0.34 per cent in the Centro Nacional de la Transfusión Sanguínea and 0.15 per cent in the Banco Central de Sangre, IMSS. Most of the HBsAg+ blood donors were 21 to 40 years old (87.8%); 21.9 per cent had IgM antibodies against HBc and just 2.4 per cent were HBeAg positive. Forty one (26.9%) of 152 relatives had one or more of the HBV markers, 3.9 per cent were HBsAg carriers and 1.3 per cent were HBeAg positive. In the infected relatives group 36.6 per cent were ancestory or brothers and just 14.6 per cent of wives were infected. None of the HBsAg+ blood donors or his relatives had antibodies against delta agent. These results support the fact that the frequency of asymptomatic carriers of HBsAg in the volunteer blood donors group is similar to he frequency in the general population and identifies the group of relatives as those with the highest risk to acquire HBV infection.

Extubación precoz en pacientes pediatricos sometidos a cirugía cardiovascular / Precocious extubation in pediatric patients subjected vascular to cardiovascular surgery

Está planteada la controversia entre el uso de la ventilación mecánica "profiláctica" y la extubación precoz de los pacientes sometidos a cirugía cardiovascular. En este trabajo analizamos morbilidad, mortalidad e incidencia de reintubación en 130 pacientes pediátricos operados en nuestro centro, en los cuales aplicamos parámetros definidos para decidir o no la extubación precoz al término de la operación. En los 93 pacientes extubados precozmente solo fueron reintubados 4 (4.3%), por complicaciones. La mortalidad de este grupo fue del 0%. En los 37 pacientes no extubados 27 (73%) presentaron complicaciones y la mortalidad fue 8 casos (21.6%). Concluimos que los parámetros de extubación precoz son confiables y que la ventilación mecánica no debe utilizarse en forma rutinaria e indiscriminada

Extubación precoz en pacientes pediatricos sometidos a cirugía cardiovascular / Precocious extubation in pediatric patients subjected vascular to cardiovascular surgery

Está planteada la controversia entre el uso de la ventilación mecánica "profiláctica" y la extubación precoz de los pacientes sometidos a cirugía cardiovascular. En este trabajo analizamos morbilidad, mortalidad e incidencia de reintubación en 130 pacientes pediátricos operados en nuestro centro, en los cuales aplicamos parámetros definidos para decidir o no la extubación precoz al término de la operación. En los 93 pacientes extubados precozmente solo fueron reintubados 4 (4.3%), por complicaciones. La mortalidad de este grupo fue del 0%. En los 37 pacientes no extubados 27 (73%) presentaron complicaciones y la mortalidad fue 8 casos (21.6%). Concluimos que los parámetros de extubación precoz son confiables y que la ventilación mecánica no debe utilizarse en forma rutinaria e indiscriminada (AU)