Randomized, double-blind, placebo-controlled clinical trial measuring the effect of a dietetic food on dermatologic scoring and pruritus in dogs with atopic dermatitis.

BACKGROUND: Canine atopic dermatitis (AD) is a common condition that often requires multimodal therapy. Including a diet in the multimodal management of AD may reduce medication doses, saving pet owners money and reducing side effects. The objective of this randomized, double-blind, placebo-controlled clinical trial was to determine if a diet fortified in antioxidants, polyphenols, and omega-3 fatty acids can reduce the clinical signs of AD. Forty client-owned dogs with AD were enrolled in the study and assigned to either an enriched diet (diet B) or control diet (diet A) for 60-days. CADESI-4 index scores and owner-reported pruritus scores were measured periodically. RESULTS: Total CADESI-4 index scores for dogs eating diet B were lower on day 60 compared to baseline (P = 0.003). There was no statistical difference in scores for dogs eating diet A over a 60-day period. Diet B dogs had 25 and 49% reductions in CADESI-4 index scores on days 30 and 60, respectively (P = 0.0007) while diet A had no change over the study period. When comparing the percent change in owner-reported pruritus scores, diet B also performed better than diet A. By day 60, owners feeding diet B to their dogs reported a significant reduction (P < 0.0001) of 46.4% in itching, while those on diet A reported a 26.8% reduction, which was not statistically significant (P = 0.08). CONCLUSIONS: These study results demonstrate feeding a diet enriched with ingredients to improve skin health and reduce inflammation improves the clinical signs of AD in dogs.

Impacto de unas sesiones formativas en el tratamiento de los episodios de broncoespasmo en urgencias / Impact of training sessions on the treatment of bronchospasm episodes in the emergency department

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Psychogenic cough: a diagnosis of exclusion.

Cough is the most common respiratory symptom and a common reason for consultation in both primary care and emergency departments, as a result of family concerns. We report an 11-year-old girl who complains of constant cough episode for 4 hours without any rest. After sequential treatment with nebulized salbutamol and budesonide, dexamethasone, codeine, and midazolam, the patient showed transient improvement, with cough disappearing altogether, but 10 minutes later, it started over with the same intensity from the beginning. When she got distracted and talked, the access decreased, starting again when the word "cough" or similar terms were mentioned in front of her. She remained asymptomatic for 2 hours, after which her symptoms began similarly to the initial, coinciding with taking 1 tablet of clarithromycin, so it was decided to start a continuous infusion of midazolam, with the cough disappearing completely after 15 minutes of starting the infusion. One hour after starting the infusion, the child fell asleep. At waking, the cough had disappeared. She continued treatment with oral codeine for 3 days, showing no relapse. It is important to include psychogenic cough in the differential diagnosis of persistent or recurrent chronic cough and asthma that is difficult to control and communicate that diagnostic criteria are based on indicative symptoms (cough access only when awake), with normal radiology, spirometry, and bronchoscopy, to avoid misdiagnosis and inadequate pharmacological actions. Successful treatment is based on recognizing the underlying cause and use of different forms of cognitive-behavioral therapies that aim to break the habit.

Application of Pediatric Appendicitis Score on the emergency department of a secondary level hospital.

BACKGROUND: Acute appendicitis is the most common surgical emergency during childhood. Accurate early diagnosis is important to avoid complications and unnecessary interventions. In 2002, Samuel developed the Pediatric Appendicitis Score (PAS) based on a series of data obtained from anamnesis, physical examination, and laboratory tests. The main purpose of this study was to check the validity of PAS and its applicability to our population. METHODS: Prospective observational study, carried out at Hospital Río Hortega (Valladolid, Spain), between June 2009 and May 2010. Data from 101 patients who presented to the emergency department experiencing abdominal pains were recovered. RESULTS: A total of 101 patients were included in the study: 55 were boys and 46 girls. The mean age was 9.51 (2.76) years. Diagnosis was acute appendicitis in 28 patients, adenitis in 8 patients, nonspecific abdominal pain in 51 patients, and other diagnoses in 14 patients. The mean (SD) PAS for children with and without appendicitis was 7.43 (1.79) and 4.97 (1.67), respectively (P < 0.001). CONCLUSIONS: With a cutoff PAS of 3 or lower, there were no patients diagnosed with acute appendicitis; hence, these patients could be discharged without any image studies. If all the patients with a PAS of 8 or higher undergo surgery, we would find in our sample a 4.95% rate of negative appendicectomy, less than other studies have shown. The application of this score in the emergency department could help in the decision making process, aiding in the identification of patients with a low risk of having appendicitis and enabling a better use of resources by avoiding unnecessary diagnostic tests.

Predictive factors of low risk for bacteremia in infants with urinary tract infection.

We studied 140 febrile infants between 30 and 90 days of age who had a positive urine culture to analyze the risk for complications. Patients with a healthy appearance and C-reactive protein blood value less than 40 mg/L had a very small probability of complications.

[Prevalence of infection by carbapenem-resistant Acinetobacter baumannii in Spain (1999-2005)]. / Prevalencia de infecciones por Acinetobacter baumannii resistente a carbapenemas en España (1999-2005).

INTRODUCTION: This study determines the prevalence of infections by carbapenem-resistant Acinetobacter baumannii (CRAB) in Spain, and identifies trends over time, geographical variations, and factors associated with resistance. METHODS: Yearly prevalence surveys (EPINE, Estudio de Prevalencia de las Infecciones Nosocomiales en España) during 1999 to 2005 were analyzed, including data on the site of infection, culture, and antimicrobial susceptibility, and characteristics of the patients and hospitals. RESULTS: On average, 246 hospitals/year participated in the survey. A total of 1168 A. baumannii isolates were identified, yielding an infection prevalence rate of 3/1,000 hospitalized patients. Fourteen percent of isolates were related to community-onset infections. The most frequent sites of infection were the respiratory tract (42.2%), surgical wound (15.1%), urinary tract (12.9%), and skin (11.7%). Rate of carbapenem resistance was 34.5% (95% CI, 31.8-37.3), and was even higher among ICU patients (43.8%; 95% CI, 38.9%-48.7%). There were considerable differences between Spanish regions, with the highest rates of resistance in central regions. Higher resistance rates were observed in respiratory tract infections (43%) and catheter-related bacteremia (47.6%) than among other sites of infection (P =.003). Main factors associated with CRAB identified by multivariate analysis were surgical or tracheostomy procedures, use of invasive devices such as urinary, nasogastric, or central venous catheters, and mechanical ventilation, as well as male gender and pressure sores. CONCLUSIONS: The prevalence of CRAB in Spain is very high. Differences in resistance rates have been observed according to geographic region and area of hospitalization. Several invasive procedures, as well as male gender and pressure sores, are associated with higher rates of carbapenem resistance.

Prevalencia de infecciones por Acinetobacter baumannii resistente a carbapenemas en España (1999-2005) / Prevalence of Infection by Carbapenem-resistant Acinetobacter baumannii in Spain (1999-2005)

Introducción. Los objetivos de este estudio son determinar la prevalencia de las infecciones por Acinetobacter baumannii resistente a carbapenemas (ABRC) en España, su tendencia, diferencias geográficas, e identificar factores asociados a su resistencia. Métodos. Se analizaron las encuestas anuales del estudio de prevalencia EPINE (1999-2005), incluyendo la localización de la infección, los cultivos y sus resistencias antibióticas, y las características de los pacientes y de los hospitales. Resultados. Participaron 246 hospitales/año. Se identificaron 1.168 aislamientos de A. baumannii (tasa de prevalencia de infecciones por A. baumannii de 3/1.000). El 14% correspondieron a infecciones de inicio en la comunidad. La tasa de resistencia a carbapenemas fue del 34,5% (intervalo de confianza del IC95% [IC 95%]: 31,8-37,3) y del 43,8% (IC 95%: 38,9-48,7) en unidad de cuidados intensivos. Se observó una mayor resistencia en las comunidades autónomas de la zona centro. Las infecciones respiratorias (43%) y las bacteriemias asociadas a dispositivo (47,6%) se asociaron a una mayor tasa de resistencia (p 5 0,003). Los principales factores asociados a ABRC son los procedimientos quirúrgicos o de traqueotomía, la utilización de dispositivos invasivos, tales como la sonda urinaria o nasogástrica, los catéteres venosos centrales y la ventilación mecánica, así como el sexo varón y la presencia de úlceras por presión. Conclusiones. La prevalencia de ABRC es muy elevada y se encuentran diferencias por zonas geográficas, y por áreas de hospitalización. Determinados procedimientos invasivos, así como el sexo varón y las úlceras por presión, se encuentran asociados a una mayor tasa de resistencia carbapenemas (AU)

Introduction. This study determines the prevalence of infections by carbapenem-resistant Acinetobacter baumannii (CRAB) in Spain, and identifies trends over time, geographical variations, and factors associated with resistance. Methods. Yearly prevalence surveys (EPINE, Estudio de Prevalencia de las Infecciones Nosocomiales en España) during 1999 to 2005 were analyzed, including data on the site of infection, culture, and antimicrobial susceptibility, and characteristics of the patients and hospitals. Results. On average, 246 hospitals/year participated in the survey. A total of 1168 A. baumannii isolates were identified, yielding an infection prevalence rate of 3/1,000 hospitalized patients. Fourteen percent of isolates were related to community-onset infections. The most frequent sites of infection were the respiratory tract (42.2%), surgical wound (15.1%), urinary tract (12.9%), and skin (11.7%). Rate of carbapenem resistance was 34.5% (95% CI, 31.8-37.3), and was even higher among ICU patients (43.8%; 95% CI, 38.9%-48.7%). There were considerable differences between Spanish regions, with the highest rates of resistance in central regions. Higher resistance rates were observed in respiratory tract infections (43%) and catheter-related bacteremia (47.6%) than among other sites of infection (P 5.003). Main factors associated with CRAB identified by multivariate analysis were surgical or tracheostomy procedures, use of invasive devices such as urinary, nasogastric, or central venous catheters, and mechanical ventilation, as well as male gender and pressure sores. Conclusions. The prevalence of CRAB in Spain is very high. Differences in resistance rates have been observed according to geographic region and area of hospitalization. Several invasive procedures, as well as male gender and pressure sores, are associated with higher rates of carbapenem resistance (AU)

[Update of the cost of needlestick injuries in hospital healthcare personnel]. / Actualización del coste de las inoculaciones accidentales en el personal sanitario hospitalario.

OBJECTIVES: To update the mean cost of each hepatitis B, hepatitis C and HIV follow-up in health personnel accidentally exposed to blood and body fluids, to stratify the cost depending on the serological status of the source, and to identify the items that account for the main part of the cost. METHODS: A cost analysis was carried out. The postexposure program was modeled on a decision tree combining probabilities (percentage of each type of source depending on positivity for the three viruses and immunization status of the health worker against hepatitis B) and monetary costs (euros in 2002). Costs included salaries, laboratory, pharmacy (including postexposure prophylaxis), water, gas and electricity, cleaning, telephone, medical and office equipment, amortization and lost productivity. RESULTS: The mean cost was 388 euros, ranging from 1,502 euros (source positive for hepatitis C and HIV) to 172 euros (source negative for the three viruses). If the source was hepatitis B positive, the mean cost was 666 euros when the injured worker was not immunized and was 467 euros if the worker was immunized. Serologic tests and postexposure prophylaxis accounted for the main part of the cost. CONCLUSIONS: The high cost suggests the need for appropriate risk evaluation to avoid unnecessary follow-ups. The model used allows the cost of each potentially avoidable episode to be determined and could be used in any hospital to perform an economic evaluation of new preventive devices.

Actualización del coste de las inoculaciones accidentales en el personal sanitario hospitalario / Update of the cost of needlestick injuries in hospital healthcare personnel

Objetivos: Actualizar el coste medio a que asciende cada seguimiento de la hepatitis B y C, así como la infección por el virus de la inmunodeficiencia humana (VIH), en el personal sanitario que ha experimentado una inoculación accidental, desagregar el coste según el estado serológico de la fuente e identificar los apartados que influyen en mayor grado en la cuantía de este resultado. Métodos: Se realizó una descripción de los costes. El programa post exposición se modelizó en un árbol de decisión que combinaba las probabilidades (porcentaje de cada tipo de fuente en función de su positividad a los 3 virus e inmunización del accidentado frente a la hepatitis B) y los costes monetarios(en euros del año 2002) relacionados con los gastos de personal, laboratorio, farmacia (incluida la profilaxis post exposición frente al VIH), energéticos, de limpieza, teléfono, material médico y de oficina, amortización y pérdidas productivas. Resultados: El coste medio de cada inoculación fue de 388 euros, con un rango de 1.502 (fuente positiva a la hepatitis C y el VIH) a 172 euros (fuente negativa a los 3 virus). Si la fuente era la hepatitis B positiva, el coste medio fue de 666 euros cuando el accidentado no estaba inmunizado, y de 467 si efectivamente lo estaba. La mayor parte del coste residió en las pruebas serológicas y la administración de profilaxis post exposición. Conclusiones: El alto coste indica una evaluación adecuada del riesgo con el fin de evitar unos seguimientos innecesarios. El modelo permite conocer el coste de cada episodio potencialmente evitable y puede aplicarse en cualquier hospital, con el objetivo de evaluar económicamente los nuevos dispositivos preventivos

Objectives: To update the mean cost of each hepatitis B, hepatitis C and HIV follow-up in health personnel accidentally exposed to blood and body fluids, to stratify the cost depending on the serological status of the source, and to identify the items that account for the main part of the cost. Methods: A cost analysis was carried out. The post exposure program was modeled on a decision tree combining probabilities(percentage of each type of source depending on positivity for the three viruses and immunization status of the health worker against hepatitis B) and monetary costs (eurosin 2002). Costs included salaries, laboratory, pharmacy (including post exposure prophylaxis), water, gas and electricity, cleaning, telephone, medical and office equipment, amortization and lost productivity. Results: The mean cost was 388 euros, ranging from 1,502 euros (source positive for hepatitis C and HIV) to 172 euros(source negative for the three viruses). If the source was hepatitis B positive, the mean cost was 666 euros when the injured worker was not immunized and was 467 euros if the worker was immunized. Serologic tests and post exposure prophylaxis accounted for the main part of the cost. Conclusions: The high cost suggests the need for appropriate risk evaluation to avoid unnecessary follow-ups. The model used allows the cost of each potentially avoidable episode to be determined and could be used in any hospital to performan economic evaluation of new preventive devices

[Adult vaccination update]. / Actualización en la vacunación del adulto.

Vaccination, as a global concept, is the most cost-effective strategy in primary prevention of communicable diseases. One of the bigger difficulties in adult population is to reach the same vaccine coverage as in childhood vaccine programs. In order to solve this deficit, strategies established in the primary level are basic, due the fact that it's the first contact of adult population with health programs. Tertiary level could help to optimize vaccine coverage in specific groups. Active immunization in adults is established evaluating factors as age and gender, but specific circumstances associated with medical conditions, treatments or occupation could extend vaccine administration in adults.

[Etiology of hospital-acquired infections in Spanish hospitals (EPINE, 1990-1999)]. / Etiología de las infecciones hospitalarias en España (EPINE, 1990-1999).

BACKGROUND: Clinical and demographic characteristics of patients, their interaction with pathogens and antimicrobial therapies are prompting changes in the epidemiology of hospital-acquired infections (HI). The knowledge of the etiology of hospital-acquired infections is valuable for the treatment of infected patients and for the prevention of HI. PATIENTS AND METHOD: We analyzed a series of 10 annual prevalence studies during the period 1990-1999 (EPINE project) in Spanish hospitals. Estimate of prevalence of infection was calculated by means of the percent distribution of every organism regarding overall identified organisms and infections. RESULTS: 40,550 HI were identified among 484,013 patients (HI prevalence = 8.4%; 95% CI, 8.3-8.5%). Gram-positive organism predominated steadily in bloodstream and surgical wound infections, while gram-negative bacilli predominated in respiratory and urinary tract infections. There was an increase in HI infections by Acinetobacter baumannii (from 1.9% in 1990 to 3.6% in 1999; P < 0.001) and Candida albicans (from 2.4 to 3.2%; P < 0.001), as well as an increase in both HI and community-acquired infections by methicillin-resistant Staphylococcus aureus [HI: from 4.7 to 40.2% (P < 0.001); community-acquired: from 2.7 to 15.6% (P < 0.001)]. CONCLUSIONS: We observed some changes in the etiology of infections over the last decade: rates of methicillin-resistant S. aureus hospital-acquired and community-acquired infections increased steadily and their initial rates multiplied by 8 and 6, respectively. Rates of HI caused by yeasts and A. baumannii increased also.

[Antimicrobial use in Spanish hospitals (EPINE, 1990-1999)]. / Utilización de los antimicrobianos en los hospitales españoles (EPINE, 1990-1999).

BACKGROUND: Monitoring of antimicrobial use and knowledge of prescription habits are some of the strategies recommended to contain the resistance to antimicrobials in hospitals. METHOD: We analyzed a series of 10 annual studies of prevalence during the period 1990-1999 (EPINE project) in Spanish hospitals. Estimates of antimicrobial use were calculated as the percent distribution of every antimicrobial related to the overall antimicrobials prescribed. RESULTS: Among 484,013 hospitalized patients, 34 to 36% were receiving antimicrobials (antibiotics > 90%). Amoxicillin-clavulanate use increased from 3.8% in 1990 up to 14.8% in 1999 (P < 0.01). Significant increases were also observed in the use of carbapenems (0.9 to 2.7%; P < 0.01), glycopeptides (1.7 to 3.7%; P < 0.01) and quinolones (8.5 to 11.3%; P < 0.01) though to a lesser degree. Conversely, the use of aminoglycosides decreased over the decade studied (15.8 to 9.4%; P < 0.01). CONCLUSIONS: Even though the use of antimicrobials has increased over the last decade, current figures are within the ranges observed in other countries. The pattern of antibiotics use has changed during this period: while the use of aminoglycosides decreased, that of -lactams plus -lactamase inhibitors, quinolones and carbapenems increased.

Etiología de las infecciones hospitalarias en España (EPINE, 1990-1999) / Etiology of hospital-acquired infections in Spanish hospitals (EPINE, 1990-1999)

FUNDAMENTO: Las características clinicodemográficas de los pacientes y su interacción con los microorganismos patógenos y los tratamientos antimicrobianos están condicionando cambios en la epidemiología de las infecciones hospitalarias (IH). El conocimiento de su etiología tiene interés para el tratamiento del paciente infectado y para la prevención de las IH. PACIENTES Y MÉTODO: Serie de 10 estudios anuales de prevalencia (proyecto EPINE) durante el período 1990-1999 en hospitales españoles. La estimación de la prevalencia de infecciones por microorganismos se calculó mediante la distribución porcentual de cada microorganismo sobre el total de microorganismos identificados y sobre el total de infecciones identificadas. Se utilizó la prueba de la 2 para tendencias. RESULTADOS: Se identificaron 40.550 IH en los 484.013 pacientes estudiados (prevalencia de IH: 8,4 por ciento; intervalo de confianza [IC] del 95 por ciento, 8,3-8,5 por ciento). De forma estable los microorganismos grampositivos predominaron en las infecciones de la sangre y de la herida quirúrgica, y los bacilos gramnegativos en las respiratorias y urinarias. Se incrementaron las infecciones por Acinetobacter baumannii (del 1,9 por ciento en 1990 al 3,6 por ciento en 1999; p < 0,001), por Candida albicans (del 2,4 al 3,2 por ciento; p < 0,001) y el porcentaje de Staphylococcus aureus resistente a la meticilina, tanto en las IH (del 4,7 al 40,2 por ciento; p < 0,001) como en las comunitarias (del 2,7 al 15,6 por ciento; p < 0,001). CONCLUSIONES: Se observaron algunos cambios en la etiología de las IH durante la pasada década. La tasa de infecciones por S. aureus resistente a la meticilina en las IH e infecciones comunitarias se incrementó de forma continua y multiplicó por 8 y por 6, respectivamente, los valores iniciales. Asimismo aumentaron las tasas de IH causadas por levaduras y A. baumannii. (AU)

Utilización de los antimicrobianos en los hospitales españoles (EPINE, 1990-1999) / Antimicrobial use in Spanish hospitals (EPINE, 1990-1999)

FUNDAMENTO: Entre las estrategias recomendadas para la contención de la resistencia a los antimicrobianos en el ámbito hospitalario se encuentran la monitorización del consumo de antimicrobianos y el estudio de los hábitos de prescripción. MÉTODO: Serie de 10 estudios anuales de prevalencia durante el período 1990-1999, en hospitales españoles. La estimación de la utilización de antimicrobianos se calculó mediante la distribución porcentual de cada antimicrobiano sobre el total de antimicrobianos prescritos. Se calculó la prueba de la 2 para tendencias. RESULTADOS: De los 484.013 pacientes hospitalizados, entre un 34 y un 36 por ciento estaban recibiendo antimicrobianos, de los cuales los antibióticos representaban más del 90 por ciento de todos ellos. El uso de amoxicilina-ácido clavulánico aumentó desde un 3,8 por ciento en 1990 hasta un 14,8 por ciento en 1999 (p < 0,01). También aumentaron significativamente la utilización de los carbapenemes (del 0,9 al 2,7 por ciento; p < 0,01), los glucopéptidos (del 1,7 al 3,7 por ciento; p < 0,01) y las quinolonas (del 8,5 al 11,3 por ciento; p < 0,01), aunque en menor magnitud. Por el contrario, el uso aminoglucósidos (del 15,8 al 9,4 por ciento; p < 0,01) fue disminuyendo a lo largo de la década. CONCLUSIONES: Aunque la utilización de los antimicrobianos se ha incrementado durante estos 10 años, las cifras actuales se sitúan en los intervalos observados en otros países. El perfil de utilización de antibióticos se modificó a lo largo de este período; disminuyó el uso de aminoglucósidos y se incrementó el consumo de las asociaciones de B-lactámicos e inhibidores de lactamasas, fluoroquinolonas y carbapenemes. (AU)