Demographic, clinical and microbiological characteristics of the first 30 human monkeypox confirmed cases attended in a tertiary hospital in Madrid (Spain), during the May-June 2022 international outbreak.

The present outbreak of Human Monkeypox (HMPX) that has begun in May 2022 and has spread across all continents in less than two months has qualitative and quantitative characteristics that make it different from the pattern of human disease previously caused by this virus. It has spread with enormous ease, affects almost exclusively adults, behaves as a sexually transmitted disease and focuses on very specific groups and transmission conditions. The high incidence in the city of Madrid in males that have sex with males (MSM) has allowed us to observe and report the experience with the first 30 cases diagnosed in our institution. Patients presented with febrile symptoms, genital and paragenital skin lesions reminiscent of smallpox, but less extensive and severe. The disease may also cause proctitis, pharyngitis and perioral lesions. The PCR test for diagnostic confirmation has been shown to be very sensitive and effective, not only in skin lesions but also in blood and other fluids such as pharyngeal, rectal exudates and blood. A very high proportion of patients with HMPX also have other sexually transmitted diseases that must be actively detected in this context. The spontaneous evolution of our patients has been good and hospitalization has been practically unnecessary. Transmission to non-sexual cohabitants and health personnel has been nonexistent and the lesions have disappeared in less than 30 days without leaving sequelae and no need for specific antiviral treatment.

Tratamiento y manejo del SAHS en niños / No disponible

No disponible

Sección de Neumología del H. Infantil Universitario Niños Jesús / Pulmonology Section H. University Children Child Jesus

La actividad asistencial e investigadora se centra principalmente en el asma, la fibrosis quística, la función pulmonar y el síndrome de apnea-hipopnea del sueño (AU)

The care and investigator activity mainly focuses on asthma, cystic fibrosis, pulmonary function and sleep apnea hypopnea syndrome (AU)

Síndrome de apnea de sueño en la infancia / No disponible

No disponible

Concordance between the Piko - 1(R) portable device and pneumotachography in measuring PEF and FEV1 in asthmatic children

Objective: To assess concordance in the measurement of peak expiratory flow (PEF) and forced expiratory volume in one second (FEV1) between the portable device Piko-1 (Ferraris) and a pneumotachograph. Patients and methods: Forced spirometry (Master Screen Jaeger) was performed according to ATS/ERS norms, selecting the best value of three curves, and three measurements with the Piko-1 were recorded, following the recommendations of the manufacturer. Results. Eighty patients between 5–18 years of age were studied. Based on the Bland-Altman method, the mean differences obtained were 9.82 (95%CI: 2.43–17.21) for PEF and 0.17 (95%CI: 0.12–0.21) for FEV1. The intraclass correlation coefficient was 0.96 (p<0,001; 95%CI: 0.93–0.97) for FEV1 and 0.93 (p<0,001; 95%CI: 0.89–0.95) for PEF. Conclusions: Piko-1 offers FEV1 measurements close to those obtained with forced spirometry, thus allowing more exact patient assessment in home-based follow-up, emergency services, or hospital wards (AU)

No disponible

Concordance between the Piko - 1 portable device and pneumotachography in measuring PEF and FEV(1) in asthmatic children.

OBJECTIVE: To assess concordance in the measurement of peak expiratory flow (PEF) and forced expiratory volume ino ne second (FEV(1)) between the portable device Piko-1 (Ferraris) and a pneumotachograph. PATIENTS AND METHODS: Forced spirometry (Master Screen Jaeger) was performed according to ATS/ERS norms, selecting the best value of three curves, and three measurements with the Piko-1 were recorded the recommendations of the manufacturer. RESULTS: Eighty patients between 5-18 years of age were studied. Based on the Bland-Altman method, the mean differences obtained were 9.82 (95%Cl: 2.43-17.21) for PEF and 0.17 (95%CL: 0.12-0.21 for FEV(1). The intraclass correlation coefficient was 0.96 (p <0,001; 95%Cl: 0.93-0.97) for PEV(1) and 0.93 (p<0,0001; 95%Cl: 0.89-0.95) for PEF. CONCLUSIONS: Piko-1 offers FEV(1) measurements close to those obtained with forced spirometry, thus allowing more exact patient assessment in home-based follow-up emergency services, or hospital wards.

Prueba de broncodilatación: ¿9% sobre el valor teórico o 12% sobre el valor basal es lo mismo? / Bronchodilator test: is 9% of the predicted value the same as 12% of the initial value?

Objetivos: La prueba de broncodilatación (PBD) es una herramienta fundamental para el estudio de la función pulmonar. El incremento del volumen espiratorio máximo en el primer segundo (FEV1) puede expresarse como valor absoluto en mililitros o como porcentaje de mejoría con respecto al valor teórico o al valor previo (basal). Al utilizar este último se puede cometer un sesgo ya que, cuanto menor sea éste mayor parecerá la respuesta. El objetivo de este estudio es determinar si existen diferencias al considerar una PBD como positiva si el incremento del FEV1 se refiere al valor teórico o al valor basal, y si estas diferencias estarían influidas por el grado de obstrucción inicial del paciente. Material y métodos: Análisis retrospectivo de los resultados de PBD realizadas entre octubre de 1997 y febrero de 2008. Se compararon los resultados utilizando como referencia un incremento del 9% sobre el FEV1 teórico y un incremento del 12% sobre el FEV1 basal. Se dividió la muestra en 3 grupos en función del grado inicial de obstrucción: no obstruido (FEV1 mayor del 80% del valor teórico), leve (FEV1 de entre el 60 y el 80% del valor teórico) y moderada a grave (FEV1 menor del 60% del valor teórico). Se calculó el índice k de concordancia entre ambos métodos. Resultados: Se analizaron 4.352 PBD. La concordancia entre ambos métodos fue muy buena (k=0,832). En el grupo sin obstrucción inicial (n=3007) el índice k fue de 0.781, en el grupo con obstrucción leve (n=1.067) el índice k fue de 0,966 y en el grupo con obstrucción moderada a grave (n=278) el índice k fue de 0,788. Conclusiones: El estudio demuestra que aunque hay una buena concordancia entre ambos índices, en los pacientes con obstrucción inicial moderada a grave y en los pacientes inicialmente no obstruidos esta concordancia tiende a ser menor (AU)

Introduction: The bronchodilator test (BDT) is an important tool used in pulmonary function. Changes in forced expiratory volume in one second (FEV1) can be expressed as absolute change, or per cent of initial or predicted value. When the initial value is used, there may be a bias, as the smaller this value is, the greater the response will be. The main objective of this study is to establish whether there is any difference in using per cent of the initial spirometry value or per cent of the predicted value in order to consider a bronchodilator test positive, and if the initial obstruction of the patient influences such differences. Material and methods: A retrospective analysis of the BDT made between October 1997 and February 2008. The results using an increase of 9% from the predicted FEV1 were compared with using 12% from the initial FEV1. The patients were divided into three groups depending on initial obstruction: no obstruction (FEV1>80% of predicted), mild (FEV1=60¨C80% of predicted) and moderate-severe (FEV1<60% of predicted). The kappa index of agreement between both methods was calculated. Results: A total of 4352 BDT were analysed. The agreement between both methods was high (k=0.832). In the group without initial obstruction (N=3007) the kappa index was 0.781, in the mild obstruction group (N=1067) the kappa index was 0.966 and in the moderate-severe group (N=278) it was 0.788. Conclusion: This study demonstrates that, although there is a good agreement between both methods, in patients with initial moderate-severe obstruction and in patients without initial obstruction this agreement tends to be lower (AU)

[Bronchodilator test: is 9% of the predicted value the same as 12% of the initial value]. / Prueba de broncodilatación: ¿9% sobre el valor teórico o 12% sobre el valor basal es lo mismo?

INTRODUCTION: The bronchodilator test (BDT) is an important tool used in pulmonary function. Changes in forced expiratory volume in one second (FEV1) can be expressed as absolute change, or per cent of initial or predicted value. When the initial value is used, there may be a bias, as the smaller this value is, the greater the response will be. The main objective of this study is to establish whether there is any difference in using per cent of the initial spirometry value or per cent of the predicted value in order to consider a bronchodilator test positive, and if the initial obstruction of the patient influences such differences. MATERIAL AND METHODS: A retrospective analysis of the BDT made between October 1997 and February 2008. The results using an increase of 9% from the predicted FEV1 were compared with using 12% from the initial FEV1. The patients were divided into three groups depending on initial obstruction: no obstruction (FEV1>80% of predicted), mild (FEV1=60-80% of predicted) and moderate-severe (FEV1<60% of predicted). The kappa index of agreement between both methods was calculated. RESULTS: A total of 4352 BDT were analysed. The agreement between both methods was high (k=0.832). In the group without initial obstruction (N=3007) the kappa index was 0.781, in the mild obstruction group (N=1067) the kappa index was 0.966 and in the moderate-severe group (N=278) it was 0.788. CONCLUSION: This study demonstrates that, although there is a good agreement between both methods, in patients with initial moderate-severe obstruction and in patients without initial obstruction this agreement tends to be lower.

Episodios paroxísticos no epilépticos tipo trastorno motor paroxístico / Non-epileptic paroxysmal episodes: paroxysmal motor disorders

Los episodios paroxísticos no epilépticos tipo trastorno motor paroxístico son aquellas manifestaciones neurológicas de aparición generalmente brusca, de breve duración, con síntomas y signos primordialmente motores, originados por una disfunción cerebral de origen diverso que tienen en común el carácter excluyente de no ser epilépticos; es decir, que su mecanismo de producción no obedece a una descarga hipersincrónica neuronal. Estos trastornos motores paroxísticos son más frecuentes que las verdaderas crisis epilépticas y en ocasiones puede ser muy difícil diferenciarlos de éstas, sobre todo en el grupo de los neonatos y lactantes pequeños, siendo muchas veces necesario realizar una vídeo-EEG- poligrafía de sueño o bien una monitorización vídeo-EEG continuada para lograr llegar al diagnóstico. La realización de una anamnesis completa y minuciosa, con un análisis detallado de las circunstancias de aparición y la patocronía del episodio paroxístico, es la clave para un correcto diagnóstico diferencial. Según la semiología clínica y la evolución natural, distinguimos 5 grupos de trastornos motores paroxísticos: a) fenómenos motores normales exagerados; b) alteraciones benignas y transitorias del movimiento; c) movimientos tipo hábitos motores y episodios de autoestimulación motriz; d) movimientos anormales sintomáticos; y e) otros trastornos motores paroxísticos de origen heterogéneo. En la mayoría de los casos no se necesita un tratamiento específico y tan sólo es importante informar a los padres sobre la evolución natural benigna que tienen la gran mayoría de estos episodios (AU)

Non-epileptic motor paroxysmal episodes are clinical disorders of usually sudden appearance, brief and originated by a cerebral dysfunction of diverse causes with a common character of being non epileptic. These non-epileptic motor paroxysmal events are more frequent than epileptic events and are sometimes confounded with true epileptic fits. Differential diagnosis could be very difficult in neonates and young infants and is often necessary to us video EEG-polygraphy techniques or video- EEG-monitoring recordings in order to make a definitive diagnosis. Careful and detailed clinical history and wide evaluation of the circumstances of occurrence and the characteristics and duration of the paroxysmal episodes are the most important diagnostic clues in this group of patients. According to clinical semiology and natural course of these paroxysmal episodes, we can describe 5 groups of disorders: a) Exacerbated normal motor events; b) Transient and benign motor paroxysmal disorders; c) Rhythmic habit patterns and behavioral motor disorders; d) Symptomatic abnormal movements; e) Other motor paroxysmal disorders with heterogeneous clinical relevance. Most of cases do not need any specific treatment and it´s only important to explain to parents about the benign natural course of paroxysmal disorder (AU)

Migraña como episodio paroxístico no epiléptico / Migraine as a non-epileptic paroxysmal episode

La migraña es un episodio paroxístico no epiléptico que produce una amplia gama de síndromes neurológicos en el niño y adolescente. A veces es muy difícil diferenciar si estos episodios son o no realmente epilépticos y tan sólo la realización de una historia clínica minuciosa y detallada puede llevarnos a diagnosticar correctamente a estos pacientes. La migraña en la infancia agrupa 4 grandes categorías diagnósticas, incluyendo: migraña con aura (migraña clásica), migraña sin aura (migraña común), migraña complicada y equivalentes migrañosos. La migraña con aura se define como típica o atípica según la duración y la patocronía del aura migrañosa y es muchas veces difícil de diferenciar de las crisis epilépticas parciales. En el grupo de la migraña con aura atípica se incluyen procesos con distinto significado pronóstico como son la migraña hemipléjica esporádica, la migraña hemipléjica familiar, la migraña basilar, la fenomenología visual positiva persistente y el síndrome de “Alicia en el País de las Maravillas”. La migraña complicada describe diversos síndromes como son el status migrañoso, el infarto migrañoso y las crisis precipitadas por el aura migrañosa. Es importante también conocer el síndrome de hemiplejía alternante de lactante y su relación con la migraña, la epilepsia y las distonías paroxísticas. Por otra parte, en este artículo se analizan las complejas interrelaciones del binomio migraña-epilepsia y la coexistencia de estas 2 patologías en la población pediátrica (AU)

Migraine is a paroxysmal non epileptic episode that causes several neurological syndromes in childhood and adolescence. Sometimes is very difficult to differentiate if these condition is non epileptic or epileptic in fact and only a detailed clinical story has a real diagnostic value. Migraine in children can be divided into four large groups: migraine with aura (classic migraine9, migraine without aura (common migraine), complicated migraine and migraine equivalent syndromes. Migraine with aura can be typical or atypical according to duration and natural course of aura and is often difficult to differentiate from true focal epileptic seizures. Migraine with atypical aura includes different paroxysmal syndromes like sporadic hemiplegic migraine, familial hemiplegic migraine, basilar artery migraine, persistent positive visual phenomena and “Alice in Wonderland” syndrome. Complicated migraine encloses different syndromes like migraine status, migraine stroke and epileptic seizures triggered by migraine. Otherwise we describe the infrequent syndrome called alternating hemiplegia of infancy and its relationship with migraine, epilepsy and paroxysmal dystonias. In this paper we analyse too the different correlations between migraine and epilepsy and the coexistence of these two syndrome in pediatric population (AU)

Utilidad del índice de brouillette para el diagnóstico del síndrome de apnea del sueño infantil / Usefulness of the Brouillette index in the diagnosis of obstructive sleep apnea syndrome in childrenintroduction

OBJETIVO: La poligrafía durante el sueño permite diferenciar entre los niños con ronquido primario y aquellos con síndrome de apnea obstructiva de sueño (SAOS). Se ha propuesto que un índice clínico (índice de Brouillette) podría resultar de utilidad para clasificar a los niños en los que se sospecha esta enfermedad y evitar con ello un número importante de estudios poligráficos. PACIENTES Y MÉTODOS: Se han evaluado 192 niños consecutivos con hipertrofia adenoamigdalar, sin enfermedades asociadas ni anomalías craneofaciales, remitidos a una consulta de neumología infantil por sospecha de SAOS. En todos los casos se calculó el índice de Brouillette (IB) clasificando a los pacientes en los siguientes grupos: a) sin SAOS (IB 3,5). Para el diagnóstico poligráfico se analizaron dos criterios diferentes para diferencias el SAOS del ronquido primario: índice apnea/hipopnea >= 3 o >= 5. RESULTADOS: El índice de Brouillette permitió clasificar correctamente sólo el 23 por ciento de los pacientes. En la gran mayoría de los niños este índice no fue útil para distinguir entre ronquido primario y SAOS, y fue por lo tanto necesario realizar un estudio de poligrafía nocturna. En un grupo de niños (10,9o 6,4 por ciento según el criterio empleado para el diagnóstico) el índice de Brouillette hubiera clasificado mal a los pacientes. CONCLUSIÓN: Sobre la base de estos resultados puede concluirse que el índice de Brouillette no constituye una prueba diagnóstica suficientemente útil para distinguir entre pacientes con ronquido primario y SAOS en una consulta de neumología infantil (AU)

Antigens of Amblyomma americanum ticks recognized by repeatedly infested sheep.

Sera were taken from 3 sheep that had been infested 5 times with Amblyomma americanum and that exhibited manifestations of humoral depression to homologous antigens and anti-tick resistance. Proteins extracted from the intestine or salivary glands of unfed ticks or salivary glands from partially (3-day) fed ticks were analyzed by polyacrylamide gel electrophoresis (PAGE) and sodium dodecyl sulfate-PAGE. Antigens recognized by the sheep in the same materials before and after each infestation were analyzed by western blots. The sheep responded to 44 antigens. Nine to 23 antigens were recognized by the preinfestation sera and the sera of 2 gnotobiotic sheep. Four antigens (34,000, 36,500, 38,000, and 115,000 MW) were revealed conspicuously by the serum of the first infestation but very weakly or not at all by the sera of the third infestation onward. Two antigens (35,500 and 29,000 MW) from fed salivary glands were revealed only by sera taken after manifestations of resistance had appeared. These antigens may be responsible for anti-tick protection. The 29,900 MW antigen was present also in salivary extracts of Boophilus microplus.

Manifestations of immunity in sheep repeatedly infested with Amblyomma americanum ticks.

Three sheep were infested 4 times with 100 Amblyomma americanum tick pairs and kept indoors until the natural termination of the infestations. Characteristics of the tick populations that show efficiency of feeding, fertility, and offspring development, and ELISA antibodies to tick salivary gland extracts were studied at each infestation. On average, female ticks fed on tick-naive sheep detached at 12.1 +/- 0.2 (mean +/- standard error) days, weighed 492 +/- 16.8 mg, engorged 40.7 mg per day, and 35% survived to detachment during the first infestation. During the fourth infestation, they detached at 17.3 +/- 0.8 days, weighed 321 +/- 14.4 mg, engorged 18.8 mg per day on average, and 23% survived to detachment. On average, oviposition of female ticks fed on tick-naive sheep started at 11.8 +/- 0.6 days of detachment, the egg mass weighed 236 +/- 13.2 mg, 43% of the female weight turned into eggs, and 89% of the ticks that detached survived to oviposition during the first infestation. During the fourth infestation, oviposition started at 15.1 +/- 0.5 days, the eggs weighed 103 +/- 9.9 mg, 13% of the tick weight became eggs, and 67% of the ticks survived to oviposition. On average, eclosion started at 35.4 +/- 0.9 days of oviposition and 83% of the egg batches hatched in the first infestation. During the fourth infestation, eclosion started on day 34.9 +/- 0.7, and 47% of the egg batches hatched. Anti-tick resistance was expressed as an inhibition of feeding, fertility, and offspring development.(ABSTRACT TRUNCATED AT 250 WORDS)

Limited efficacy of levamisole against adults of Dirofilaria immitis in a dog.

A dog with chronic dirofilariasis (Dirofilaria immitis) was given 15 doses of 12 or 24 mg of levamisole/kg of body weight in 6 treatments within 96 days. Concentration of microfilariae in the blood was determined before and after treatment, and Aedes triseriatus mosquitoes were fed on the dog 1 to 5 days after each treatment and examined for D immitis larvae. Several adult worms were recovered from the dog 160 days after the end of the treatments.