Clinical Relevance of RSV and SARS-CoV-2 Coinfections in Infants and Young Children.

We analyzed the frequency, clinical impact and severity of respiratory syncytial virus (RSV) and SARS-CoV-2 coinfections in a single pediatric center between March 2020 and January 2023. Compared to single RSV infections, RSV/SARS-CoV-2 coinfections were uncommon (2.1%), occurred more frequently during circulation of omicron, and were associated with increased disease severity as defined by longer hospitalization and increased need for high-flow nasal cannula.

Clinical Phenotype of Respiratory Syncytial Virus Bronchiolitis before and during the Coronavirus Disease 2019 Pandemic.

OBJECTIVE: The main objective of this report was to comprehensively analyze the clinical characteristics of children hospitalized with respiratory syncytial virus (RSV) infections in 2021 during the coronavirus disease 2019 (COVID-19) pandemic and to compare them with those in the five previous RSV seasons. We hypothesized that the clinical and demographic features of children hospitalized with RSV infection in 2021 were different from those hospitalized in previous respiratory seasons. STUDY DESIGN: In this retrospective observational study, children younger than 2 years hospitalized with RSV bronchiolitis from January 1, 2015, to December 31, 2021, at the Department of Pediatrics of the Hospital Gregorio Marañón, Madrid, Spain, were included. We compared the clinical characteristics of children hospitalized with RSV bronchiolitis in the five seasons before the COVID-19 pandemic and during the subsequent off-seasonal surge of RSV infections. RESULTS: We found a significant reduction in hospitalizations for RSV bronchiolitis during the usual winter epidemic period due to the COVID-19 pandemic. Children hospitalized with RSV infection in 2021, during the COVID-19 pandemic, were older than children hospitalized in the prepandemic period (2015-2020; 4.0 [1.6-9.2] vs. 3 [1.5-6.5] months; p < 0.01). We also found shorter duration of oxygen days during the COVID-19 period compared with previous respiratory seasons (3 [2-5] vs. 4 [2-6] days; p = 0.02). CONCLUSION: The COVID-19 pandemic modified the RSV seasonality with a significant reduction in RSV hospitalizations during the expected 2020-2021 season and a reappearance of RSV 7 months later than expected. We also found changes in the median age of children with RSV bronchiolitis during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic compared with the prepandemic RSV seasons and shorter duration of oxygen days suggesting a modest reduction in disease severity. We hypothesize that this observation reflects the lack of RSV circulation in the previous months (April 2020-March 2021), with a larger pool of vulnerable infants that had not been previously infected. KEY POINTS: · The COVID-19 pandemic shifted RSV seasonality.. · RSV children hospitalized during the pandemic were older.. · Modest reduction in disease severity was observed during the pandemic..

Validation of the inverse method for the determination of the access flow with thermodilution.

INTRODUCTION: Thermodiluction is a widely used method for measuring vascular access flow (QA). Among the possibilities of TD, the reverse method (MI) can be beneficial in the execution time, without impact on the dialysis efficacy (Kt). However, it is not a sufficiently studied technique. METHOD: Transversal study of 117 arteriovenous fistulas (AVF). Two QA measurements were taken with the method described by the manufacturer (MR) and another with MI. MI is bases in the obtention of an inverted recirculation registry at the beginning of the session and a single subsequent recirculation measurement with the lines in normal position. In the concordance analysis, the Bland-Altman method and Cohen's Kappa index were used. RESULTS: Very good concordance between MR and MI was evidenced for QA below 700 ml/min, but it worsens as flow increases. The median variability between the MR measurements (intra-method variability) was 3.4% (-17.13). This value did not differ from the median variability generated between MR and MI (inter-method variability), which was 2% (-14, 12) (P = 0.287). The degree of agreement between the two to identify AVFs susceptible to intervention was very good (K = 0.834). The time spent using the MI was significantly shorter (P = 0.000) without evidence of variations in the Kt of the measurement sessions (P = 0.201). CONCLUSIONS: The thermodiluction MI is valid to determine the flow of the vascular access, especially in Qa lower than 700 ml/min, with great time savings, simplification of the procedure and without modifying the dialysis efficiency. The variability between the measurement by MR and MI is similar to that of MR. The concordance between methods in identifying potentially pathological AVFs is very good.

Age and respiratory syncytial virus etiology in bronchiolitis clinical outcomes.

Background: Respiratory syncytial virus (RSV) is the most frequent cause of bronchiolitis. Precise and updated information about demographic characteristics, clinical manifestations, and risk factors for severe disease are needed for optimal implementation of upcoming new therapeutic and preventive interventions. Objectives: The main goals of this study were to define the epidemiology of acute bronchiolitis in hospitalized young children during 5 calendar years in Spain; evaluate the differences in clinical manifestations between children hospitalized with RSV infection and those hospitalized with non-RSV infection; and identify demographic characteristics, clinical parameters, and risk factors associated with disease severity. Methods: We performed a retrospective review of the medical records of children younger than 2 years who were hospitalized with bronchiolitis between January 2015 and December 2019. We constructed multivariable models to identify independent predictors of disease severity defined as length of hospital stay (LOS), pediatric intensive care unit (PICU) admission, and need for a high-flow-nasal canula (HFNC). Results: From January 2015 to December 2019, 1437 children were hospitalized with bronchiolitis and met the inclusion criteria. The proportion of children hospitalized with bronchiolitis caused by RSV increased significantly during the study period, from 60% to 65% (P = .03). The children with RSV bronchiolitis were younger than those with non-RSV bronchiolitis (median age = 3 months [interquartile range = 1.5-6.5 months] vs 4 months [interquartile range = 2-7.5 months], respectively (P < .01). The children younger than 6 months with RSV bronchiolitis had enhanced disease severity compared with those with non-RSV bronchiolitis, as defined by an LOS of more than 4 days, severity scores, need for an HFNC, intravenous fluids, enteral feeding, and PICU admissions (P < .01). Age younger than 6 months and RSV-positive etiology were independently associated with greater odds of PICU admission, need for an HFNC, and longer LOS. Conclusion: This study identified differences in disease severity between young children with RSV bronchiolitis and those with non-RSV bronchiolitis. These differences are particularly significant in children younger than 6 months, who comprise a group of infants with suboptimal innate immunity to RSV and may benefit from new preventive strategies.

Nasal and Fecal Microbiota and Immunoprofiling of Infants With and Without RSV Bronchiolitis.

Bronchiolitis associated with the respiratory syncytial virus (RSV) is the leading cause of hospitalization among infants aged < 1 year. The main objective of this work was to assess the nasal and fecal microbiota and immune profiles in infants with RSV bronchiolitis, and to compare them with those of healthy infants. For this purpose, a total of 58 infants with RSV-positive bronchiolitis and 17 healthy infants (aged < 18 months) were recruited in this case-control study, which was approved by the Ethics Committee of the Hospital Gregorio Marañón. Nasal and fecal samples were obtained and submitted to bacterial microbiota analysis by 16S rDNA sequencing and to analysis of several immune factors related to inflammatory processes. Nasal samples in which Haemophilus and/or Moraxella accounted for > 20% of the total sequences were exclusively detected among infants of the bronchiolitis group. In this group, the relative abundances of Staphylococcus and Corynebacterium were significantly lower than in nasal samples from the control group while the opposite was observed for those of Haemophilus and Mannheimia. Fecal bacterial microbiota of infants with bronchiolitis was similar to that of healthy infants. Significant differences were obtained between bronchiolitis and control groups for both the frequency of detection and concentration of BAFF/TNFSF13B and sTNF.R1 in nasal samples. The concentration of BAFF/TNFSF13B was also significantly higher in fecal samples from the bronchiolitis group. In conclusion, signatures of RSV-associated bronchiolitis have been found in this study, including dominance of Haemophilus and a high concentration of BAFF/TNFSF13B, IL-8 and sTNF.R1 in nasal samples, and a high fecal concentration of BAFF/TNFSF13B.

Longitudinal plasma cytokine concentrations and recurrent wheezing after RSV bronchiolitis.

BACKGROUND: Respiratory syncytial virus (RSV) bronchiolitis in young children has been associated with increased risk for developing recurrent wheezing, but the underlying mechanisms, are not completely defined. We hypothesized that RSV induces a disregulated immune response defined by a distinct cytokine profile in infants at increased risk for developing recurrent wheezing. METHODS: Previously healthy infants less than 12 months of age hospitalized with a first episode of RSV bronchiolitis were enrolled and blood samples and clinical and epidemiological data collected. A group of healthy non-infected controls were enrolled in parallel. Children were followed longitudinally and subsequent blood samples collected in RSV-infected infants at one month and at one year after hospital discharge to measure longitudinal plasma concentrations of IFN-γ, TNF-α, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12, IL-17 and IL1-ß. Risk of post-RSV wheezing was assessed by Poisson modelling. RESULTS: From October 2008 to March 2012 we enrolled 37 infants hospitalized with RSV bronchiolitis and 9 healthy age-matched controls. Within the RSV cohort, 17 (46%) children developed recurrent wheezing within the following 12 months. Plasma cytokine profiles measured during the acute infection were similar in children who developed recurrent wheezing versus those who did not, but lower in healthy controls vs RSV infants who subsequently developed wheezing. At one month and 12 months post-acute RSV infection, infants who developed recurrent wheezing had higher IFN-γ plasma concentrations versus those with no-wheezing (p < 0.05). Moreover, IFN-γ concentrations were identified as independent predictor of post-RSV wheezing. CONCLUSIONS: Children with RSV-associated recurrent wheezing had persistently elevated plasma concentrations of IFN-γ for a year after acute infection, suggesting that this cytokine could be used as a biomarker for risk of recurrent wheezing and possibly plays a role in the pathogenesis of this condition.

Glucose Biosensor Based on Disposable Activated Carbon Electrodes Modified with Platinum Nanoparticles Electrodeposited on Poly(Azure A).

Herein, a novel electrochemical glucose biosensor based on glucose oxidase (GOx) immobilized on a surface containing platinum nanoparticles (PtNPs) electrodeposited on poly(Azure A) (PAA) previously electropolymerized on activated screen-printed carbon electrodes (GOx-PtNPs-PAA-aSPCEs) is reported. The resulting electrochemical biosensor was validated towards glucose oxidation in real samples and further electrochemical measurement associated with the generated H2O2. The electrochemical biosensor showed an excellent sensitivity (42.7 µA mM-1 cm-2), limit of detection (7.6 µM), linear range (20 µM-2.3 mM), and good selectivity towards glucose determination. Furthermore, and most importantly, the detection of glucose was performed at a low potential (0.2 V vs. Ag). The high performance of the electrochemical biosensor was explained through surface exploration using field emission SEM, XPS, and impedance measurements. The electrochemical biosensor was successfully applied to glucose quantification in several real samples (commercial juices and a plant cell culture medium), exhibiting a high accuracy when compared with a classical spectrophotometric method. This electrochemical biosensor can be easily prepared and opens up a good alternative in the development of new sensitive glucose sensors.

Non-enzymatic screen-printed sensor based on PtNPs@polyazure A for the real-time tracking of the H2O2 secreted from living plant cells.

Monitoring of hydrogen peroxide (H2O2) in living cells has high significance for understanding its functions. We herein report an enzymeless H2O2 sensor consisting of a previously activated screen-printed carbon electrode modified with Pt nanoparticles electrogenerated on a supporting conductive layer of polyazure A-dodecyl sulfate. This electrode was used to investigate the dynamic process of H2O2 release from living grapevine cells under different (a)biotic stresses. The modified surfaces were characterized by FESEM/EDX, EIS and cyclic voltammetry. Sensor analytical performance was studied in a cell culture medium under aerobic conditions, as required for cell survival. In relation to the synergistic effect between the metal nanoparticles and the conjugated polymer, this electrode showed good stability, excellent analytical performance combined with a rapid response (<2s) and limit of detection of 24.9 nM in the culture medium. The modified electrodes could fulfill the real-time measurement requirement of H2O2 release from living plant cells to the extracellular medium operating continuously, even in experiments lasting more than 12 h. Methyl jasmonate, L-methionine, clopyralid and the fungus Botrytis cinerea were the eliciting agents chosen to induce oxidative stress in the plant cells. This work demonstrates the huge potential of this sensor for the real-time tracking of the H2O2 released from living cells under different physiological conditions.

Detección de factores de riesgo de reingreso prevenible en la hospitalización pediátrica / Detection of risk factors for preventable paediatric hospital readmissions

Introducción y objetivos: La tasa de reingresos hospitalarios es un indicador de calidad de la asistencia hospitalaria. El objetivo de este trabajo es describir factores de riesgo de reingreso prevenible en la hospitalización pediátrica. Material y métodos: Estudio analítico, retrospectivo, unicéntrico realizado en las plantas de Pediatría de un hospital terciario (junio de 2012 a noviembre de 2015). Se definió reingreso al que acontecía en los primeros 30 días del ingreso previo: muy precoz (en menos de 48 h), precoz (2-7 días) y tardío (a partir de 7 días). Se definió reingreso prevenible al que ocurrió en los primeros 15 días y por la misma causa del primer ingreso. Se analizaron variables epidemiológicas y clínicas. Se realizó un estudio univariante y posteriormente multivariante. Resultados: En el período de estudio ingresaron en las plantas de Pediatría General Hospitalaria 5.459 pacientes y reingresaron 226 (tasa de reingreso del 4,1%). Cuando la tasa de ocupación hospitalaria es mayor del 70%, el porcentaje global de reingresos es significativamente mayor (8,5 vs. 2,5%), p < 0,001. En el análisis de regresión de Cox se objetivó que la presencia de enfermedad de base y el número de visitas a urgencias desde el alta son factores de predicción de reingreso prevenible. Conclusiones: La tasa de reingresos es mayor en los períodos de mayor presión asistencial. El reingreso de los pacientes con patología crónica de base es prevenible, y por lo tanto hay que diseñar estrategias para intentar evitarlo

Introduction and objectives: Readmission rate is an indicator of the quality of hospital care. The aim of the study is to identify potential preventable factors for paediatric readmission. Material and methods: A descriptive, analytical, longitudinal, and single centre study was carried out in the Paediatric Hospitalisation ward of a tertiary hospital during the period from June 2012 to November 2015. Readmission was defined as the one that occurs in the first 30 days of previous admission, as very early readmission if it occurs in the first 48 hours, early readmission in the 2-7 days, and late readmission if occurs after 7 days. Preventable readmission is defined as one that takes place in the first 15 days and for the same reason as the first admission. Epidemiological and clinical variables were analysed. A univariate and multivariate study was carried out. Results: In the study period, 5,459 patients were admitted to the paediatric hospital, of which 226 of them were readmissions (rate of readmission: 4.1%). When the hospital occupation rate was greater than 70%, the overall percentage of readmissions was significantly higher (8.5% vs 2.5%; P < .001). In the multivariate analysis, it was found that having a chronic disease and the number of visits to emergency care units before admission, are predictive factors of preventable readmission. Conclusions: The rate of readmissions is greater in the periods of higher care pressure. The readmission of patients with chronic condition is preventable, and therefore strategies must be designed to try to avoid them

Disminuyendo el dolor en los procedimientos invasivos durante la hospitalización pediátrica: ¿ficción, realidad o realidad virtual? / Reducing the pain in invasive procedures during paediatric hospital admissions: Fiction, reality or virtual reality?

Introducción: La realización de procedimientos invasivos dolorosos con fines terapéuticos o diagnósticos en pacientes pediátricos hospitalizados es frecuente en la práctica diaria. Se deben buscar estrategias encaminadas a disminuir el dolor y la ansiedad durante estas técnicas, como el uso de realidad virtual (RV). Materiales y métodos: Se realizó un estudio observacional, analítico y prospectivo, en el cual se incluyeron todos los pacientes pediátricos hospitalizados de entre 4 y 15 años que precisaron procedimientos invasivos. Se recogieron escalas de valoración de dolor y ansiedad a los pacientes (ajustadas a su edad), familiares y personal sanitario y se comparó el uso de la RV, de manera aislada y asociado a una crema anestésica (prilocaína/lidocaína crema 2,5%), con un grupo control en el que no se utilizó ninguna técnica analgésica. Resultados: Se incluyeron 58 pacientes, de los cuales 38 usaron la RV (grupo RV) y 20 pacientes no recibieron ninguna técnica analgésica ni de distracción (grupo control). El uso de RV disminuyó las puntuaciones en la mediana de las escalas de dolor en niños, familiares y personal sanitario (grupo control 4/5 vs. grupo RV 1/5, p < 0,001), y en las escalas de ansiedad en niños (grupo control 4/5 vs. grupo RV 1/5, p = 0,001). En el análisis multivariante, el número de punciones (R2: 0,5; β: 0,6; p = 0,01) y la ausencia de técnicas coadyuvantes (β: -0,9; p = 0,02) se asociaron con puntuaciones más elevadas en la escala del dolor en niños. Comentarios: El empleo de RV disminuy:e el dolor y la ansiedad durante la realización de procedimientos invasivos en pacientes pediátricos hospitalizados

Introduction: Potentially painful invasive procedures are often performed for diagnostic or therapeutic purposes in hospitalised paediatric patients. Approaches, such as virtual reality (VR), should be sought in order to minimise pain and anxiety during these procedures. Materials and methods: Hospitalised patients between 4 and 15-years-old requiring an invasive procedure were included. Pain and anxiety evaluation scales were given to children, relatives and health workers. A comparison was made with patients in whom VR was used (with or without concomitant use of a prilocaine/ lidocaine 2.5% analgesic cream) and patients in whom neither VR nor analgesic cream were used. Results: The study included 58 patients, 38 in the VR group and 20 in the control group. Pain scores, as performed by patients, relatives and health workers, significantly decreased in the VR group (control group median 4/5 vs. VR group median 1/5, P < .001). Patient-reported anxiety scales were also lower in the VR group (control group median 4/5 vs. VR group 1/5, P = .001). The number of punctures (R2: 0.5, β: 0.6; P = .01) and the lack of analgesic techniques (β: -0.9; P = .02) were associated with higher scores in patient-reported pain scales. Comments: The use of VR can reduce pain and anxiety during invasive procedures in hospitalized children

¿Cuál es el flujo inicial idóneo en la oxigenoterapia de alto flujo para el tratamiento de la bronquiolitis en las plantas de hospitalización? / What is the optimal flow on starting high-flow oxygen therapy for bronchiolitis treatment in paediatric wards?

Introducción: La oxigenoterapia de alto flujo (OAF) es un tratamiento seguro y eficaz de la bronquiolitis en las plantas de hospitalización. Se desconoce cuál es el flujo óptimo para iniciar esta terapia. Nuestro objetivo es analizar si hay diferencias en la evolución de los pacientes según el flujo inicial empleado. Métodos: Durante el periodo 2014-2016 se realizó un estudio clínico observacional y analítico de cohortes prospectivas en lactantes ingresados por bronquiolitis que precisaron OAF. Se establecieron dos cohortes en función del flujo inicial: cohorte 1: flujo 15 l/min (OAF-15); cohorte 2: flujo 10l/min (OAF-10). El fracaso terapéutico se definió como la presentación de pausas de apnea o a la ausencia de mejoría clínica en las siguientes 12-24 h. Se construyeron modelos probabilísticos multivariantes para identificar variables predictivas de fracaso terapéutico. Resultados: Se incluyeron 57 pacientes. Mediana de edad, 4 meses (RIQ2-13). Recibieron tratamiento con OAF-10 el 54% y con OAF-15 el 46%. En la cohorte OAF-15 la frecuencia respiratoria empezó a disminuir en la primera hora y en la cohorte OAF-10 a partir de las 6 primeras horas (p = 0,03). En la cohorte OAF-10 ocurrió fracaso terapéutico en el 71%, frente al 15% de la OAF-15 (p < 0,01). Precisaron ingreso en la UCIP el 35%, en la cohorte OAF-10 vs el 18% en la OAF-15 (p = 0,11). No se encontraron efectos adversos en ninguna de las cohortes. Conclusiones: La OAF a 15l/min en el tratamiento de la bronquiolitis es segura y eficaz, consigue una mejoría precoz de la frecuencia respiratoria y tiene un menor porcentaje de fracaso terapéutico

Introduction: High-flow nasal cannula (HFNC) is a safe and effective treatment in bronchiolitis in paediatric wards. The optimal flow on starting HFNC is still unknown. The main aim of this study was to determine if there were differences in clinical outcome of patients according the initial flow. Methods: A prospective, observational and analytical study was conducted between 2014 and 2016 on infants admitted with bronchiolitis and who required HFNC. Two cohorts were established according to the initial flow: cohort 1: flow 15 L/min (HFNC-15), and cohort 2: flow 10 L/min (HFNC-10). Treatment failure was defined as the presentation of apnoea or the absence of clinical improvement in the first 12-24 hours. Multivariate probabilistic models were built to identify predictive variables of treatment failure. Results: A total of 57 patients were included. The median age was 4 months (IQR 2-13), and 54% received treatment with HFNC-10 and 46% with HFNC-15. In HFNC-15 cohort, respiratory rate (RR) decreased in the first hour, and in the HFNC-10 cohort in the first 6hours (P = .03). In HFNC-10 cohort, treatment failure rate was 71%, compared to 15% of HFNC-15 (P < .01). Admission to PICU was required in 35% of the HFNC-10 group vs 18% in HFNC-15 (P = .11). No adverse effects were found. Conclusions: The use of HFNC 15L/min in bronchiolitis treatment in paediatric wards is safe and effective, achieves a faster improvement of respiratory rate and has a lower treatment failure rate

[Detection of risk factors for preventable paediatric hospital readmissions]. / Detección de factores de riesgo de reingreso prevenible en la hospitalización pediátrica.

INTRODUCTION AND OBJECTIVES: Readmission rate is an indicator of the quality of hospital care. The aim of the study is to identify potential preventable factors for paediatric readmission. MATERIAL AND METHODS: A descriptive, analytical, longitudinal, and single centre study was carried out in the Paediatric Hospitalisation ward of a tertiary hospital during the period from June 2012 to November 2015. Readmission was defined as the one that occurs in the first 30 days of previous admission, as very early readmission if it occurs in the first 48hours, early readmission in the 2-7 days, and late readmission if occurs after 7 days. Preventable readmission is defined as one that takes place in the first 15 days and for the same reason as the first admission. Epidemiological and clinical variables were analysed. A univariate and multivariate study was carried out. RESULTS: In the study period, 5,459 patients were admitted to the paediatric hospital, of which 226 of them were readmissions (rate of readmission: 4.1%). When the hospital occupation rate was greater than 70%, the overall percentage of readmissions was significantly higher (8.5% vs 2.5%; P<.001). In the multivariate analysis, it was found that having a chronic disease and the number of visits to emergency care units before admission, are predictive factors of preventable readmission. CONCLUSIONS: The rate of readmissions is greater in the periods of higher care pressure. The readmission of patients with chronic condition is preventable, and therefore strategies must be designed to try to avoid them.

[What is the optimal flow on starting high-flow oxygen therapy for bronchiolitis treatment in paediatric wards?] / ¿Cuál es el flujo inicial idóneo en la oxigenoterapia de alto flujo para el tratamiento de la bronquiolitis en las plantas de hospitalización?

INTRODUCTION: High-flow nasal cannula (HFNC) is a safe and effective treatment in bronchiolitis in paediatric wards. The optimal flow on starting HFNC is still unknown. The main aim of this study was to determine if there were differences in clinical outcome of patients according the initial flow. METHODS: A prospective, observational and analytical study was conducted between 2014 and 2016 on infants admitted with bronchiolitis and who required HFNC. Two cohorts were established according to the initial flow: cohort1: flow 15L/min (HFNC-15), and cohort2: flow 10L/min (HFNC-10). Treatment failure was defined as the presentation of apnoea or the absence of clinical improvement in the first 12-24hours. Multivariate probabilistic models were built to identify predictive variables of treatment failure. RESULTS: A total of 57 patients were included. The median age was 4months (IQR 2-13), and 54% received treatment with HFNC-10 and 46% with HFNC-15. In HFNC-15 cohort, respiratory rate (RR) decreased in the first hour, and in the HFNC-10 cohort in the first 6hours (P=.03). In HFNC-10 cohort, treatment failure rate was 71%, compared to 15% of HFNC-15 (P<.01). Admission to PICU was required in 35% of the HFNC-10 group vs 18% in HFNC-15 (P=.11). No adverse effects were found. CONCLUSIONS: The use of HFNC 15L/min in bronchiolitis treatment in paediatric wards is safe and effective, achieves a faster improvement of respiratory rate and has a lower treatment failure rate.

Design and Characterization of Effective Ag, Pt and AgPt Nanoparticles to H2O2 Electrosensing from Scrapped Printed Electrodes.

The use of disposable screen-printed electrodes (SPEs) has extraordinarily grown in the last years. In this paper, conductive inks from scrapped SPEs were removed by acid leaching, providing high value feedstocks suitable for the electrochemical deposition of Ag, Pt and Ag core-Pt shell-like bimetallic (AgPt) nanoparticles, onto screen-printed carbon electrodes (ML@SPCEs, M = Ag, Pt or AgPt, L = metal nanoparticles from leaching solutions). ML@SPCEs were characterized by scanning electron microscopy, cyclic voltammetry and electrochemical impedance spectroscopy. The results were compared to those obtained when metal nanoparticles were synthesised using standard solutions of metal salts (MS@SPCEs). Both ML@SPCEs and MS@SPCEs exhibited similar cyclic voltammetric patterns referred to the electrochemical stripping of silver or the adsorption/desorption of hydrogen/anions in the case of platinum, proving leaching solutions extremely effective for the electrodeposition of metallic nanoparticles. The use of both ML@SPCEs and MS@SPCEs proved effective in enhancing the sensitivity for the detection of H2O2 in phosphate buffer solutions (pH = 7). The AgPtL@SPCE was used as proof of concept for the validation of an amperometric sensor for the determination of H2O2 within laundry boosters and antiseptic samples. The electrochemical sensor gave good agreement with the results obtained by a spectrophotometric method with H2O2 recoveries between 100.6% and 106.4%.

Tratamiento con oxigenoterapia de alto flujo en las crisis asmáticas en la planta de hospitalización de pediatría: nuestra experiencia / Treatment with high-flow oxygen therapy in asthma exacerbations in a paediatric hospital ward: Experience from 2012 to 2016

Objetivo: Analizar la experiencia de tratamiento con OAF en pacientes ingresados por crisis asmática (CA) en una planta de hospitalización pediátrica (PHP), así como analizar la diferencia de la evolución según sean tratados de entrada con flujos de 15lpm o inferiores a 15l pm. Métodos: Estudio retrospectivo y analítico en niños (4 a 15 años) ingresados por CA en la PHP de un hospital terciario entre 2012 y 2016. Se compararon 2 grupos de pacientes: los tratados con OAF y los tratados con oxigenoterapia convencional; se construyó un modelo de regresión logística para identificar variables predictivas de necesidad de OAF. Se comparó la evolución de los pacientes en función del flujo de inicio de la OAF (15l pm vs <15l pm). Resultados: Se incluyeron 536 pacientes con CA, de los que 40 (7,5%) precisaron OAF. La mediana de edad fue de 5 (4-6) años. La OAF en los pacientes con CA produjo una reducción en la frecuencia cardiaca, frecuencia respiratoria y Pulmonary Score en las primeras 3-6horas de tratamiento. En el análisis multivariante los pacientes con una mayor puntuación en el PS y un mayor número de ingresos previos precisaron con más frecuencia OAF. Los pacientes tratados con un flujo de inicio de 15lpm ingresaron menos frecuentemente en UCIP que aquellos con flujo inicial inferior a 15lpm (13% vs. 47%, p = 0,05). Conclusión: La OAF como tratamiento de las CA en las PHP parece ser una terapia de gran utilidad. El Pulmonary Score y el número de ingresos previos permite identificar un grupo de riesgo de precisar OAF

Objective: To assess the experience with oxygen therapy with a high flow nasal cannula (HFNC) in hospital on patients with asthmatic exacerbation (AE) in a paediatric ward, and to assess the clinical outcome according with the initial oxygen flow (15l pm or < 15l pm). Methods: This was a retrospective study of children aged 4 to 15 years with AE admitted to a paediatric ward in a tertiary level hospital between 2012 and 2016. Two groups of patients were compared; Group 1: patients treated with HFNC, and Group 2: patients treated with conventional oxygen therapy. A logistic regression model was constructed in order to identify predictive variables of HFNC. The clinical outcome of the patients was also compared according to the initial flow of HFNC (15l pm VS <15l pm). Results: The study included a total of 536 patients with AE, 40 (7.5%) of whom required HFNC. The median age was 5 (4-6) years. Heart rate (HR), respiratory rate (RR) and Pulmonary Score (PS) significantly decreased at 3-6 hours after starting HFNC in Group 1. In the multivariate analysis, patients with high Pulmonary Score values and greater number of previous admissions required HFNC more frequently. Patients treated with an initial flow of 15lpm were admitted less frequently to the PICU than those with an initial flow less than 15lpm (13% vs 47%, p = .05). Conclusion: HFNC seems to be a useful therapy for asthma exacerbation in paediatric wards. Severity of Pulmonary Score and the number of previous admissions could enable a risk group that needs HFNC to be identified

[Reducing the pain in invasive procedures during paediatric hospital admissions: Fiction, reality or virtual reality?] / Disminuyendo el dolor en los procedimientos invasivos durante la hospitalización pediátrica: ¿ficción, realidad o realidad virtual?

INTRODUCTION: Potentially painful invasive procedures are often performed for diagnostic or therapeutic purposes in hospitalised paediatric patients. Approaches, such as virtual reality (VR), should be sought in order to minimise pain and anxiety during these procedures. MATERIALS AND METHODS: Hospitalised patients between 4 and 15-years-old requiring an invasive procedure were included. Pain and anxiety evaluation scales were given to children, relatives and health workers. A comparison was made with patients in whom VR was used (with or without concomitant use of a prilocaine/ lidocaine 2.5% analgesic cream) and patients in whom neither VR nor analgesic cream were used. RESULTS: The study included 58 patients, 38 in the VR group and 20 in the control group. Pain scores, as performed by patients, relatives and health workers, significantly decreased in the VR group (control group median 4/5 vs. VR group median 1/5, P<.001). Patient-reported anxiety scales were also lower in the VR group (control group median 4/5 vs. VR group 1/5, P=.001). The number of punctures (R2: 0.5, ß: 0.6; P=.01) and the lack of analgesic techniques (ß: -0.9; P=.02) were associated with higher scores in patient-reported pain scales. COMMENTS: The use of VR can reduce pain and anxiety during invasive procedures in hospitalized children.

[Treatment with high-flow oxygen therapy in asthma exacerbations in a paediatric hospital ward: Experience from 2012 to 2016]. / Tratamiento con oxigenoterapia de alto flujo en las crisis asmáticas en la planta de hospitalización de pediatría: nuestra experiencia.

OBJECTIVE: To assess the experience with oxygen therapy with a high flow nasal cannula (HFNC) in hospital on patients with asthmatic exacerbation (AE) in a paediatric ward, and to assess the clinical outcome according with the initial oxygen flow (15lpm or <15lpm). METHODS: This was a retrospective study of children aged 4 to 15 years with AE admitted to a paediatric ward in a tertiary level hospital between 2012 and 2016. Two groups of patients were compared; Group 1: patients treated with HFNC, and Group 2: patients treated with conventional oxygen therapy. A logistic regression model was constructed in order to identify predictive variables of HFNC. The clinical outcome of the patients was also compared according to the initial flow of HFNC (15lpm VS <15lpm). RESULTS: The study included a total of 536 patients with AE, 40 (7.5%) of whom required HFNC. The median age was 5 (4-6) years. Heart rate (HR), respiratory rate (RR) and Pulmonary Score (PS) significantly decreased at 3-6hours after starting HFNC in Group 1. In the multivariate analysis, patients with high Pulmonary Score values and greater number of previous admissions required HFNC more frequently. Patients treated with an initial flow of 15lpm were admitted less frequently to the PICU than those with an initial flow less than 15lpm (13% vs 47%, p=.05). CONCLUSION: HFNC seems to be a useful therapy for asthma exacerbation in paediatric wards. Severity of Pulmonary Score and the number of previous admissions could enable a risk group that needs HFNC to be identified.

A Comparative Study of Poly(Azure A) Film-Modified Disposable Electrodes for Electrocatalytic Oxidation of H2O2: Effect of Doping Anion.

In the present paper, poly(azure A) (PAA) films were electrosynthetized in the presence of different doping anions on disposable screen-printed carbon electrodes (SPCEs). The anions used included inorganic monoatomic (chloride and fluoride), inorganic polyatomic (nitrate and sulfate) and organic polyatomic (dodecyl sulfate, DS) species. The coated electrodes thus obtained were characterized by electrochemical techniques and SEM. They showed improved electrocatalytic activities towards hydrogen peroxide oxidation compared to that of a bare SPCE. In particular, the insertion of DS anions inside PAA films provided a special sensitivity to the electrocatalysis of H2O2, which endowed these electrodes with promising analytical features for H2O2 quantification. We obtained a wide linear response for H2O2 within a range of 5 µM to 3 mM and a limit of detection of 1.43 ± 0.10 µM (signal-to-noise ratio of 3). Furthermore, sensitivity was 72.4 ± 0.49 nA·µM-1∙cm-2 at a relatively low electrocatalytic oxidation overpotential of 0.5 V vs. Ag. The applicability of this boosted system was tested by the analysis of H2O2 in commercial samples of a hair lightener and an antiseptic and was corroborated by spectrophotometric methods.

Percepción de los adolescentes sobre el ingreso hospitalario: Importancia de la humanización de los hospitales infantiles / Survey of adolescent perception of hospital admission: The importance of hospital humanisation

Introducción: La humanización de la asistencia sanitaria conlleva considerar al paciente como un ser integral, y proporcionar asistencia más allá de los cuidados médicos, abarcando áreas como la social, emocional, espiritual y relacional. Objetivo: Conocer las necesidades de los adolescentes hospitalizados y los déficits percibidos por estos en la asistencia sanitaria. Sujetos y método: Estudio transversal descriptivo realizado a través de una encuesta anónima, dirigido a pacientes ingresados de entre 12-16 años. La encuesta estaba formada por 2 partes: preguntas abiertas para exponer sus necesidades, indicar aspectos positivos o negativos de la hospitalización, y sugerencias de mejora, y preguntas cerradas con posibles respuestas afirmativas o negativas, y escalas numéricas del 1 al 10 para cuantificar los resultados. Se llevó a cabo un pilotaje previo en 6 pacientes adolescentes como prueba de factibilidad y de comprensión de todos los apartados. Resultados: Se obtuvieron un total de 39 encuestas de pacientes, con una mediana de edad de 14 años. La experiencia más desagradable percibida durante el ingreso fue la realización de pruebas invasivas. El 95% de ellos padeció dolor y el 17% sintió en algún momento que se iba a realizar algún procedimiento sin su pleno conocimiento. Más del 75% demandaba más entretenimiento, siendo la no disponibilidad de Wi-Fi el elemento más reclamado. Conclusiones: La población estudiada mostró necesidades que deben ser consideradas en el momento de la hospitalización, destacando: cognitivas (necesidad de obtener información clara y extensa), sociales (mantener el contacto y las relaciones con el exterior, familiares y amigos), emocionales (la enfermedad y sus procesos diagnóstico-terapéuticos crearán alteraciones en el estado anímico) y prácticas (los aspectos ambientales y arquitectónicos pueden mejorar o empeorar la percepción del ingreso hospitalario). Todos estos factores han demostrado que pueden contribuir al restablecimiento de la salud de una forma más temprana.

Introduction: The humanisation of health care involves considering the patient as an integral human being, providing assistance beyond medical care, and covering other fields such as social, emotional, spiritual, or relational areas. Objective: To evaluate the requirements and concerns of the hospitalised children. Subjects and method: A cross-sectional, descriptive study was conducted using an anonymous questionnaire on children aged 12-16. Results: The study included 39 patients, with a median age of 14 years. The most unpleasant experience during the hospitalisation was the invasive procedures. Almost all (95%) of patients suffered from pain, and 17% of them felt at some point that a procedure was performed without them being fully aware. More than 75% of children asked for more entertainment, with the lack of Wi-Fi being the more demanded item. Conclusions: The needs of the population included in this survey, showed the importance to consider cognitive (necessity of obtaining clear and extensive information), social (maintaining everyday relationships), emotional (illness and its diagnostic and therapeutic procedures often generate mood disorders), and practical (environmental and architectural aspects can lead to either an improvement or a worsening of the hospitalisation perception) factors. All of these factors have shown a beneficial contribution, leading to an earlier recovery of health.

[Survey of adolescent perception of hospital admission. The importance of hospital humanisation]. / Percepción de los adolescentes sobre el ingreso hospitalario. Importancia de la humanización de los hospitales infantiles.

INTRODUCTION: The humanisation of health care involves considering the patient as an integral human being, providing assistance beyond medical care, and covering other fields such as social, emotional, spiritual, or relational areas. OBJECTIVE: To evaluate the requirements and concerns of the hospitalised children. SUBJECTS AND METHOD: A cross-sectional, descriptive study was conducted using an anonymous questionnaire on children aged 12-16. RESULTS: The study included 39 patients, with a median age of 14 years. The most unpleasant experience during the hospitalisation was the invasive procedures. Almost all (95%) of patients suffered from pain, and 17% of them felt at some point that a procedure was performed without them being fully aware. More than 75% of children asked for more entertainment, with the lack of Wi-Fi being the more demanded item. CONCLUSIONS: The needs of the population included in this survey, showed the importance to consider cognitive (necessity of obtaining clear and extensive information), social (maintaining everyday relationships), emotional (illness and its diagnostic and therapeutic procedures often generate mood disorders), and practical (environmental and architectural aspects can lead to either an improvement or a worsening of the hospitalisation perception) factors. All of these factors have shown a beneficial contribution, leading to an earlier recovery of health.