Impacto de las nuevas guías para el manejo de recién nacidos de riesgo de sepsis precoz por estreptococo del grupo / Impact of the new guidelines for management of newborns at risk of early sepsis due to Group B streptococcus

Introducción y objetivos: Las recomendaciones para la prevención de la sepsis neonatal precoz por estreptococo del grupo B (EGB) de los Centers for Disease Control and Prevention han sido revisadas en el año 2010. El objetivo de este estudio es conocer su impacto sobre los hijos de madres colonizadas por EGB en cuanto a realización de pruebas complementarias y número de ingresos. Material y métodos: Estudio de cohortes retrospectivo de recién nacidos de madres colonizadas por EGB, con edad de gestación igual o superior a 36 semanas, nacidos en el segundo semestre de 2010 y 2012, antes y después de la implantación del nuevo protocolo. Se compara la frecuencia de realización de estudios complementarios e ingresos hospitalarios entre ambos periodos. Resultados: Ambas cohortes (152 casos en 2010 y 130 en 2012) fueron homogéneas en cuanto a tasas de colonización materna, control obstétrico, sexo, edad gestacional, tiempo prolongado de bolsa rota, presencia de corioamnionitis e indicación y administración de profilaxis antibiótica materna. No hubo ningún caso de sepsis precoz por EGB en ninguno de los dos periodos. El nuevo protocolo evitó la solicitud de estudios complementarios en un 88 % (Pfe= 0,88. IC: 0,39-0,96) y el número de ingresos un 48% (Pfe= 0,481. IC: -0,648-0,864). Conclusiones: La aplicación del nuevo protocolo ha disminuido significativamente el número de pruebas complementarias solicitadas y el número de ingresos sin que se observe un aumento del número de casos de sepsis precoz por EGB

Background: Guidelines for prevention of perinatal infection Group B Streptococcus (GBS) has been revised in 2010 and new early-onset sepsis (EOS) algorithms have been applied. Aim: To know the impact of this new algorithm on ECO evaluations, admissions and EOS-GBS cases detection. Methods: A retrospective cohort study was performed, including neonates born at > 36 week's, with positive maternal detection of GBS, in two periods of time: from July to December 2010 (previous to new EOS algorithm) and from July to December 2012. The following data was compared: evaluations and admissions. Statistical were performed using the Student t test for quantitative variables and chi square test for categorical. Preventable fraction exposed (Pfe) was used to quantify the impact of new algorithm. Results: One hundred and fifty-two neonates were included in 2010 and 130 in 2012. No significant differences were found in terms of sex, GBS positive mothers, obstetric care, gestational age, chorioamnionitis, indication and maternal antibiotic administration. There were no cases of neonatal GBS infection in both periods. In 2012 a decrease of 88% in blood EOS evaluation was obtained (Pfe= 0.88, IC: 0.39-0.96). The number of admissions for suspected early GBS sepsis was reduced by 48.1%. (Pfe= 0.481. IC: -0.648-0.864) Conclusions. Implementation of the new EOS algorithm resulted in a decrease of EOS evaluations, and the number of admissions for suspected sepsis

Combined anti CXC receptors 1 and 2 therapy is a promising anti-inflammatory treatment for respiratory diseases by reducing neutrophil migration and activation.

Neutrophil infiltration and activation in the lung are important pathophysiological features in COPD, severe asthma and bronchiectasis mostly mediated by CXCL8 and CXCL1 via CXCR1 and CXCR2. No thorough study to date has been performed to compare the anti-inflammatory effect profile of dual CXCR1/2 vs. selective CXCR2 antagonists in relevant human neutrophil assays and pulmonary inflammation models. Dual CXCR1/2 (SCH527123, diaminocyclobutandione-1) and selective CXCR2 (SB265610, thiopyrimidine-1) antagonist activity and receptor residence time were determined by [(35)S]GTPγS binding in human (h)- and guinea pig (gp)-CXCR1 and CXCR2 overexpressing membranes. h-neutrophil chemotaxis, degranulation and ROS production were established using CXCL8 or CXCL1 to evaluate dual CXCR1/2- or selective CXCR2-dependent activities. LPS-induced lung inflammation in gp was selected to assess in vivo potency. Dual CXCR1/2 antagonists blocked both CXCL8 and CXCL1-induced h-neutrophil functions and [(35)S]GTPγS binding. In contrary, selective CXCR2 antagonists displayed significantly reduced potency in CXCL8 -mediated h-neutrophil responses despite being active in CXCR2 assays. Upon LPS challenge in gp, administration of SCH527123 inhibited the increase of neutrophils in BALF, modestly reduced blood neutrophils and induced minor neutrophil accumulation in bone marrow. Differentiation of CXCR1/2 vs. CXCR2 antagonists could not be extended to in vivo due to differences in CXCR1 receptor homology between h and gp. Dual CXCR1/2 therapy may represent a promising anti-inflammatory treatment for respiratory diseases reducing more effectively neutrophil migration and activation in the lung than a CXCR2 selective treatment. However, the in vivo confirmation of this claim is still missing due to species differences in CXCR1.

Anaphylaxis to intravenous methylprednisolone hemisuccinate in a patient with immune thrombocytopenia

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Utilidad de la serie blanca en el diagnóstico diferencial de la mononucleosis infecciosa / Utility of the white series in the differential diagnosis of infectious mononucleosis

Introducción: la mononucleosis infecciosa (MI) es una enfermedad frecuente en la infancia. Nos planteamos comparar la serie blanca de niños con sospecha de MI, en función de la serología positiva/negativa para virus Epstein-Barr (VEB), citomegalovirus (CMV) y Paul-Bunnell. Material y métodos: estudio descriptivo transversal. Se revisaron niños atendidos en Urgencias en 2010-2011, con diagnóstico de síndrome mononucleósico y serología positiva para VEB o CMV e igual número de niños con serologías negativas como grupo de control. Se compararon variables epidemiológicas, clínicas y serológicas. Resultados: se obtuvieron 50 niños con serologías positivas y 50 niños con serologías negativas (edad media de 5,81 años). Tuvieron serología positiva para VEB 44 niños, 2 para CMV y 4 para ambos. De los 48 niños con serología positiva para VEB, 26 eran Paul-Bunnell negativos y 22 positivos, siendo estos 22 niños el total de Paul-Bunnell positivos. La media de linfocitos, monocitos y basófilos fue mayor en niños con serología positiva para VEB y los neutrófilos fueron más bajos. En los dos casos con CMV positivo encontramos cifras de neutrófilos totales mayores. Ninguna edad se asoció con mayor probabilidad de VEB y Paul-Bunnell positivos. Conclusiones: existe predominio de linfocitos, monocitos y basófilos en niños con MI por VEB. El descenso de neutrófilos es la única variación analítica en los niños con MI por CMV. Estos valores analíticos pueden orientarnos en el diagnóstico de MI. Todos los niños con Paul-Bunnell positivo tenían positividad para el VEB sin relación con la edad (AU)

Introduction: the infectious mononucleosis (IM) is a common disease in childhood. We propose to compare the white series of children with suspected IM, based on serology positive/negative for Epstein -Barr Virus (EBV), Cytomegalovirus (CMV) and Paul- Bunnell. Material and methods: descriptive study. Children were reviewed, taken to hospital in 2010-2011, diagnosed with mononucleosis syndrome and positive serology for EBV or CMV, and equal number of children who were seronegative control group. Epidemiology, clinical and serological variables were compared. Results: there were 50 children with positive serology and 50 negative children (mean age 5.81 years ). EBV serology were 44 children, 2 and 4 both CMV. Of the 48 children with positive serology for EBV, 26 were negative Paul- Bunnell and 22 positive, and these 22 children total positive Paul-Bunnell. The average number of lymphocytes, monocytes and basophils was higher in children with positive serology for EBV and neutrophils were lower. Children were CMV negative but elevated neutrophils. No age was associated with increased likelihood of EBV and Paul- Bunnell positive. Conclusions: there is a predominance of lymphocytes, monocytes and basophils in children with EBV IM. The increase in neutrophils is the only analytical variation in children with CMV IM. These analytical values can guide the diagnosis of IM. All children with positive Paul- Bunnell positive for EBV had no relation with age (AU)

La alimentación complementaria del lactante: recomendaciones existentes en el Área V de Asturias / Complementary feeding of the infant: recommendations existing in Area V of Asturias (Spain)

Las recomendaciones de la introducción de la alimentación complementaria del lactante han ido sufriendo modificaciones. Hay una percepción subjetiva de que no existe consenso entre los profesionales en cuanto a las recomendaciones dadas a los padres para la introducción de los distintos alimentos. Objetivo. Conocer las pautas de alimentación dadas en los centros de salud del Área V de Asturias. Material y métodos. Estudio descriptivo transversal. Se recogieron y analizaron las hojas de recomendaciones de la alimentación complementaria que reciben los padres en los centros del Área. Las variables analizadas fueron la edad de introducción de cereal, fruta, leche de continuación, verdura, carne, pescado, huevo, legumbres, y lácteos. Para el análisis estadístico se calculó la frecuencia absoluta, relativa y porcentaje. Resultados. Sólo el 15,4% de los centros aconsejan iniciar el gluten a partir de los 4 meses en niños que reciben lactancia materna. El 30,8% de los centros no desaconsejan verduras potencialmente metahemoglobinizantes al introducir el puré de verduras. El pescado blanco se introduce en el 15,3% de centros al 8º mes, 38,5% al 9º, 38,5% al 10º y 7,7% al 11º. La yema de huevo, el 7,7% de los centros al 8º mes, el 23,1% al 9º, 23,1% al 10º y 46,1% al 11ºmes. La leche de vaca se introduce en el 7,7% de los centros al 12º mes, 7,7% entre 15º-18º, 53,8% a los 18 meses y el 30,8% no menciona cuándo debe introducirse. Conclusiones El estudio muestra una llamativa disparidad en la introducción de los alimentos entre los distintos centros. Especialmente variable resulta la edad de introducción del pescado, yema de huevo y lácteos. Solamente dos centros diferencian la edad de introducción del gluten, dependiendo del tipo de lactancia. Algunos centros introducen verduras metahemoglobinizantes al inicio del puréb (AU)

Introduction. Recommendations regarding the introduction of complementary feeding for the infant has been changing. There is a subjective perception that consensus does not exist among the professionals regarding the recommendations given to the parents for introduction of different foods. Objective. To know the feeding guidelines given in the Area V health care centers of Asturias. Material and methods..A descriptive, cross-sectional study was performed. Recommendation sheets on complementary feedings received by the parents in the Area centers were collected and analyzed. The variables analyzed were age of introduction of cereal, fruit, continuation milk, vegetable, meat, fish, egg, vegetables and dairy products. Absolute and relative frequency and percentage were calculated for the statistical analysis. Results. Only 15.4% of the centers recommend initiating gluten after 4 months in children who are breast feed. A total of 30.8% of the centers do not recommend against potentially metahemoglobin-forming vegetables when vegetable pure is introduced. White fish is introduced in 15.3% of the sites in the 8 th month, 38.5% in the 9th, 38.5% in the 10th and 7.7% in the 11 th month. Egg yolk is introduced in 7.7% of the centers in the 8 th months, 23.1% in the 9th, 23,1% in the 10th and 46.1% in the 11 th month. Cow milk is introduced in 7.7% of the centers in the 12 th month, 7.7% between the 15th and 18 th, 53.8% at 18 months and 30.8% do not mention when it should be introduced. Conclusions. The study shows a striking disagreement in the introduction of foods among the different centers. Age of introduction of fish, egg yolk and dairy products is especially different. Only two centers have differences regarding age of introduction of gluten, depending on type of breast feeding. Some centers introduce metahemoglobinproducing vegetables at the beginning of the pure (AU)