Evaluación del conocimiento de la versión cefálica externa y de las preferencias sobre el manejo de la presentación podálica a término entre mujeres en edad fértil / Evaluation of knowledge of external cephalic version and term breech presentation management preferences in women of childbearing age

Objetivo: Evaluar los conocimientos generales y preferencias iniciales de las pacientes en edad fértil en España sobre el manejo de la presentación podálica a término. Material y métodos: Se trata de un estudio transversal basado en la administración a las participantes de un cuestionario para evaluar sus conocimientos sobre la versión cefálica externa y preferencias entre esta, la cesárea y el parto de nalgas. Resultados: Doscientas mujeres participaron en el estudio. Cuarenta y uno (20,5%) habían oído hablar de la versión cefálica externa. El 29,27% por un ginecólogo, el 12,20% por una matrona, el 39,02% por conocidos, el 26,83% por internet o redes sociales y el 2,44% por la televisión. La edad, la formación académica y el hecho de estar embarazadas no fueron factores influyentes para conocer o no la versión cefálica externa. Las multíparas conocían mejor el procedimiento (OR = 2,1; IC 95%: 1,14-3,88). El 63,5% elegirían la versión cefálica externa frente al 35% que eligieron la cesárea programada. El 1,5% se decantaron por un parto de nalgas. La mayoría de las mujeres consideraron la técnica efectiva (58%) y segura tanto para la madre (55%) como para el feto (46,5%). Conclusiones: El conocimiento de las pacientes sobre la versión cefálica externa y las fuentes de las que dicen tener la información demuestran una carencia en la información que reciben por parte de ginecólogos y matronas.(AU)

Objective: To assess the knowledge and preferences for term breech management in women of childbearing age. Material and methods: Cross-sectional study based on a survey for women to evaluate heir knowledge of external cephalic version and their preferences between this procedure, vaginal breech delivery or cesarean section. Results: 200 women participated. 41 women (20.5%) had heard of external cephalic version; 29.27% from gynecologists, 12.20% from midwives, 39.02% from acquaintances, 26.83% from the internet or social networks and 2.44% from television. Multiparous woman knew more about the procedure (OR = 2.1; 95% CI:1.14-3.88). 63.5% would choose external cephalic version. 35% would prefer programmed cesarean section. 1.5% would opt for a breech delivery. Most of the women considered the technique to be effective (58%) and safe for both the mother (55%) and the fetus (46.5%). Conclusions: Patients’ knowledge of external cephalic version is poor. The results show a lack of information by their healthcare providers.(AU)

Allergic sensitization profiles among the foreign-born population in the north of Madrid.

Summary: Background. We assessed differences in allergic sensitization and clinical characteristics in a foreign-born population. Methods. Prospective, observational, descriptive study of patients aged > 12 years who were seen at the Department of Allergy, La Paz Hospital (Madrid, Spain), between January 2017 and December 2018. Patients were classified by geographical origin and ethnicity. Results. We included 150 patients (110 female) with a mean age of 38.38 years. Mean time to onset of respiratory symptoms after immigration was 8.47 years. Significant differences were observed between ethnic groups (p = 0.007). The most frequent sensitization was to grass pollen (75.2%), which was more common in South American patients (p = 0.005). We found that 59% of patients were sensitized to Cupressus and Olea pollen (higher in Asian patients, p = 0.032 and p = 0.049). Conclusions. Allergic sensitization in the foreign-born population was similar to that of the autochthonous population although differences between the groups were identified.

Severe eosinophilic allergic asthma responsive to Mepolizumaba after failure of 2 consecutive biologics

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Changes in fractional exhaled nitric oxide levels after bronchial challenge with Aspirin in patients with Aspirin-induced asthma

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Streptococcus agalactiae from pregnant women: antibiotic and heavy-metal resistance mechanisms and molecular typing.

We investigated the antibiotic and heavy-metal resistance mechanisms, virulence genes and clonal relationships of macrolide- and/or lincosamide-resistant (M+/-LR) Streptococcus agalactiae (group B Streptococcus, GBS) isolates from pregnant women in La Rioja in Northern Spain, a region with a significant immigrant population. In total 375 GBS isolates were recovered during 2011. About three-quarters of isolates were from European nationals and the remainder distributed among 23 other nationalities. Seventy-five (20%) were classified as M+/-LR strains and 28 (37%) of these were resistant to ⩾3 classes of antibiotics. Capsular serotypes III (29·3%), V (21·3%) and II (12%) were the most frequent. A wide variety of antibiotic resistance genes were detected in M+/-LR strains; notably, 5·3% harboured the lsa(C) gene associated with cross-resistance, and tet(W) was identified in a single strain. We report, for the first time, the detection of cadmium and copper resistance encoded by tcrB + cadA + cadC genes in 20 M+/-LR strains, which raises the possibility of co-selection of antibiotic and heavy-metal resistance disseminated through mobile genetic elements. The M+/-LR strains were highly diverse by DNA macrorestriction profiles (65 patterns) and 16 multilocus sequence types (STs) distributed among six clonal complexes; the most frequent were ST1, ST19, and ST12, and two strains were novel (ST586 and ST601). In conclusion, a wide diversity of genetic lineages of macrolide, lincosamide and heavy-metal- resistant GBS strains was observed in an ethnically diverse maternal population.

Osteomielitis aguda: epidemiología, manifestaciones clínicas, diagnóstico y tratamiento / Acute osteomyelitis: epidemiology, clinical manifestations, diagnosis and treatment

Introducción: El presente estudio revisa la epidemiología, las manifestaciones clínicas y el manejo de los casos de osteomielitis aguda (OA) ingresados en un hospital pediátrico de tercer nivel. Metodología: Estudio descriptivo de los pacientes menores de 15 años ingresados con el diagnóstico de OA entre 2000 y 2011, retrospectivo hasta 2006, y posteriormente prospectivo. Resultados: Se identificaron 50 pacientes (52% varones) con una mediana de edad de 2 años. La sintomatología preponderante al ingreso fue dolor (94%), impotencia funcional (90%) y fiebre (72%). Las localizaciones más frecuentes fueron el fémur (32%), la tibia (28%) y el calcáneo (22%). Se encontró leucocitosis >12.000/μl en el 56%, VSG elevada >20mm/h en un 26 y un 64% con PCR superior a 20mg/l. El 20% de los hemocultivos resultó positivo, siendo Streptococcus del grupo A el germen más frecuente (11%).La gammagrafía ósea con 99Tc permitió el diagnóstico de confirmación en todos los casos. El tratamiento antibiótico fue intravenoso (i.v.) durante una media de 10 días ±3 DE, continuándose por vía oral (v.o.) una media de 18 días ±6 DE. Tres pacientes requirieron drenaje quirúrgico. La evolución en todos los pacientes fue excelente, salvo 3 excepciones, que se resolvieron con el tiempo. Conclusiones: La actual pauta corta de tratamiento i.v. disminuyó la estancia hospitalaria. Tras su instauración no se encontraron diferencias estadísticamente significativas en la duración de la clínica, ni en la PCR en el momento del alta en comparación con las pautas prolongadas previas a 2006 (AU)

Background and aims: The present study focuses on the epidemiology, clinical and laboratory data, and management of osteomyelitis in a pediatric third level hospital. Methodology: All cases of children under 15 years-old admitted with osteomyelitis between 2000 and 2011 were retrospectively reviewed until July 2006, then prospectively from then until 2011.Results: A total of 50 patients were identified (52% males) with median age at diagnosis of 2 years. Principal onset manifestations were pain (94%), functional impairment (90%) and fever (72%). The femur (32%), fibula (28%) and calcaneus (22%) were most affected bones. Leucocytosis > 12.000/micre l was found in 56%, elevated ESR > 20 mm/h in 26%, and elevated CRP > 20 mg/L in 64%. Blood culture was positive in 20%, with group A streptococcus being the most frequently isolated bacteria (11%).All diagnoses were confirmed by a 99Tc scintigraphy bone scan. Antibiotic therapy was initially intravenously (mean time of administration: 10 days ± 3SD), followed by oral medication (mean time of administration: 18 days±6 SD). Surgery was necessary in 3 patients. Evolution of all cases was excellent, despite 3 exceptions that resolved over time. Conclusions: The current short-term intravenous therapy led to shorter hospitalizations. There were no statistically significant differences between time from clinical onset or in CRP levels at discharge compared to long-term therapies prior to 2006 (AU)

[Acute osteomyelitis: epidemiology, clinical manifestations, diagnosis and treatment]. / Osteomielitis aguda: epidemiología, manifestaciones clínicas, diagnóstico y tratamiento.

BACKGROUND AND AIMS: The present study focuses on the epidemiology, clinical and laboratory data, and management of osteomyelitis in a pediatric third level hospital. METHODOLOGY: All cases of children under 15 years-old admitted with osteomyelitis between 2000 and 2011 were retrospectively reviewed until July 2006, then prospectively from then until 2011. RESULTS: A total of 50 patients were identified (52% males) with median age at diagnosis of 2 years. Principal onset manifestations were pain (94%), functional impairment (90%) and fever (72%). The femur (32%), fibula (28%) and calcaneus (22%) were most affected bones. Leucocytosis > 12.000/µl was found in 56%, elevated ESR > 20 mm/h in 26%, and elevated CRP > 20 mg/L in 64%. Blood culture was positive in 20%, with group A streptococcus being the most frequently isolated bacteria (11%). All diagnoses were confirmed by a (99)Tc scintigraphy bone scan. Antibiotic therapy was initially intravenously (mean time of administration: 10 days ± 3 SD), followed by oral medication (mean time of administration: 18 days ± 6 SD). Surgery was necessary in 3 patients. Evolution of all cases was excellent, despite 3 exceptions that resolved over time. CONCLUSIONS: The current short-term intravenous therapy led to shorter hospitalizations. There were no statistically significant differences between time from clinical onset or in CRP levels at discharge compared to long-term therapies prior to 2006.

A European survey of professional bodies representing occupational medicine specialists.

BACKGROUND: Professional societies and associations of occupational medicine (OM) play a key role in the development and cohesion of the speciality including its interaction with other disciplines. AIMS: To understand the way the speciality operates across Europe, a survey of the current European professional bodies of OM specialists was conducted on behalf of the European Union of Medical Specialists (UEMS) section of OM. METHODS: A cross-sectional survey was conducted asking country delegates of the UEMS section of OM to complete a questionnaire exploring the characteristics and activities of their professional associations/societies. RESULTS: Twenty-four countries in total were contacted, with a response rate of 92%. In all, 78% of organizations were open to non-occupational physicians, nurses or other occupational health professionals; all except two had a fee under €200 per year, and 65% provided services with no dedicated administrative support. All organizations provided educational events, in addition to other services including website support, production of position documents, practice guidelines and quality assurance of professional practice. CONCLUSIONS: The European associations of OM specialists deliver a wide range of services and educational activities despite limited resources. Further research is needed to explore the potential strategic and political effects associated with differing membership models, assess the nature and standard of medical education provided by the different organizations, and identify areas for collaboration within Europe. Future actions within OM associations would support the development of the speciality within Europe.

Malformación adenomatoidea quística congénita / Congenital cystic adenomatous malformation

Introduction: Congenital Cystic Adenomatous Malformation (CCAM) is an infrequent entity due to an alteration in alveolar-pulmonary development. Material and Methods: A descriptive, retrospective study of newborns presenting CCAM in a tertiary care hospital in Madrid, Spain. Results: Seven patients were found. All were full term, normal weight births. Two patients showed respiratory distress at birth. Two chest x-rays were normal. CT scans showed three clear CCAM lesions, four suggestive of hybrid lesions. All were referred to medical centers with pediatric surgery for followup. Discussion: At birth, this pathology may be asymptomatic and appear as a chest x-ray finding. Long term management is complicated by infection and malignization. Conservative treatment of asymptomatic patients includes regular follow up of lesions. Surgical treatment is reserved for symptomatic or complicated patients. Conclusions: Prenatal suspicion of CCAM is important since clinical exam and radiology may be normal in neonatal period. Chest CT scans are important in confirming diagnosis and determining future surgery. More studies are necessary for the proper diagnosis and management of this disorder.

Introducción: La malformación adenomatoidea quística (MAQ) es una entidad congénita poco frecuente debida a una alteración en el desarrollo alveolar pulmonar. Pacientes y Método: Se realizó un estudio descriptivo y retrospectivo de los recién nacidos con el diagnóstico prenatal de MAQ durante 6 años en un hospital terciario de Madrid (España). Resultados: Se encontraron un total de siete pacientes. Todos fueron recién nacidos a término de peso adecuado. Dos pacientes presentaron distress respiratorio al nacimiento. Dos radiografías de tórax fueron normales. En la tomografía axial (TAC), tres lesiones fueron MAQ y cuatro fueron su-gerentes de lesión híbrida. Todos se derivaron a centro con cirugía pediátrica para seguimiento. Discusión: Al nacimiento, esta patología puede permanecer asintomática y ser un hallazgo casual en una radiografía torácica. A largo plazo el riesgo de infección y malignización complican el manejo. El tratamiento conservador, que se dirige a pacientes asintomáticos, obliga a realizar controles seriados de las lesiones. El tratamiento quirúrgico se reserva para los pacientes con sintomatología o complicaciones postnatales. Conclusiones: El diagnóstico de sospecha prenatal de MAQ es fundamental dado que la clínica y radiología pueden ser normales en el período neonatal. Se debe realizar TAC torácico para confirmar la lesión y valorar futura cirugía. Se necesitan más estudios sobre el correcto diagnóstico y manejo de esta patología.

Recién nacido con dificultad respiratoria y desplazamiento del latido cardíaco a la derecha / Neonate with respiratory distress and rightward displacement of the cardiac impulse

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Cojera súbita en un lactante afebril / Sudden lameness in an afebrile infant

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[Economic evaluation of voriconazole versus amphotericin B in the treatment of invasive aspergilosis]. / Evaluación económica del uso de voriconazol versus anfotericina B en el tratamiento de la aspergilosis invasiva.

OBJECTIVE: Invasive aspergillosis is an infection with high incidence and mortality. Voriconazole is a new antifungal agent that presents a high efficacy against Aspergillus. The aim of this evaluation was to carry out a pharmacoeconomic analysis of the use of voriconazole versus amphotericin B deoxycholate in the treatment of invasive aspergillosis in Spain. MATERIAL AND METHODS: A cost-effectiveness analysis has been performed by building a decision analytical model. Effectiveness data, probabilities of the different branches of the decision tree and consumption of healthcare resources were obtained from a clinical trial that compared voriconazole versus amphotericin B in the treatment of invasive aspergillosis and from a local expert panel in order to incorporate the model in the daily medical practice in our country. Only direct medical costs were included in the model (drug acquisition, length of hospital stay, analytical tests and treatment of therapeutic failures). The perspective chosen for this analysis was hospital assistance and the time horizon selected was 12 weeks, the maximum time that patients were followed up in the referenced clinical trial. RESULTS: Therapeutic success was reached in 52.8% of patients treated with voriconazole and in 31.6% of the group treated with amphotericin B. The cost of treating a patient with voriconazole or amphotericin B was of 56,296 and 56,382 Euros respectively, while the cost/effectiveness ratio was of 106,621 and 178,424 Euros. The incremental analysis performed shows how the use of voriconazole versus amphotericin B produces a healthcare resources saving of 406 Euros per patient. CONCLUSIONS: Voriconazole is more efficient than amphotericin B deoxycholate in the treatment of invasive aspergillosis, (thus) resulting in healthcare resources saving due to better clinical results with lower associated costs.

Evaluación económica del uso de voriconazol versus anfotericina B en el tratamiento de la aspergilosis invasiva / Economic evaluation of voriconazole versus amphotericin B in the treatment of invasive aspergilosis

Introducción: La aspergilosis invasiva es una infección con una incidencia creciente y una elevada mortalidad asociada. Voriconazoles un antifúngico que ha demostrado una alta eficacia en el tratamiento de esta enfermedad. El objetivo de este estudio ha sido efectuar un análisis farmacoeconómico del uso de voriconazol versus anfotericina B deoxicolato, en el tratamiento de la aspergilosis invasiva en nuestro país. Material y métodos: Se ha elaborado un análisis coste-efectividad empleando un modelo farmacoeconómico elaborado a través de un análisis de decisión. Los datos de efectividad, las probabilidades del árbol de decisión y el consumo de recursos, fueron obtenidos de un ensayo clínico que comparó ambas alternativas terapéuticas y de un panel de expertos local, con el fin de incorporar el modelo a la práctica médica habitual de nuestro medio. Solamente se han incluido en este análisis los costes médicos directos (coste de la medicación, días de hospitalización, analíticas y tratamiento del fallo terapéutico).La perspectiva elegida para el análisis ha sido el hospital, y el horizonte temporal escogido ha sido de 12 semanas, tiempo máximo que los pacientes fueron seguidos en el ensayo clínico de referencia. Resultados: En el estudio de referencia, los pacientes tratados con voriconazol presentaron éxito terapéutico en el 52,8 frente al31,6% en el grupo tratado con anfotericina B deoxicolato. El coste de tratar un paciente con voriconazol o con anfotericina B deoxicolato, fue de 56.296 y 56.382 € respectivamente, mientras que el cociente coste/efectividad medio fue de 106.621 y 178.424 €, al emplear ambas opciones en evaluación. El análisis coste-efectividad incremental efectuado muestra queel uso de voriconazol versus el de anfotericina B deoxicolato,supone un ahorro de recursos sanitarios de 406 € por paciente. Conclusiones: Voriconazol es una opción más eficiente que la anfotericina B deoxicolato en el tratamiento de la aspergilosis invasiva, lo que se traduce en un ahorro de recursos, derivado de producir mejores resultados clínicos con costes asociados más bajos

Objective: Invasive aspergillosis is an infection with high incidence and mortality. Voriconazole is a new antifungal agent that presents a high efficacy against Aspergillus. The aim of this evaluation was to carry out a pharmacoeconomic analysis of the use of voriconazole versus amphotericin B deoxycholate in the treatment of invasive aspergillosis in Spain. Material and methods: A cost-effectiveness analysis has been performed by building a decision analytical model. Effectiveness data, probabilities of the different branches of the decision tree and consumption of healthcare resources were obtained from a clinical trial that compared voriconazole versus amphotericin B in the treatment of invasive aspergillosis and from a local expert panel in order to incorporate the model in the daily medical practice in our country. Only direct medical costs were included in the model (drug acquisition, length of hospital stay, analytical tests and treatmentof therapeutic failures).The perspective chosen for this analysis was hospital assistance and the time horizon selected was 12 weeks, the maximum time that patients were followed up in the referenced clinical trial. Results: Therapeutic success was reached in 52.8% of patients treated with voriconazole and in 31.6% of the group treated with amphotericin B. The cost of treating a patient with voriconazole or amphotericinB was of 56,296 and 56,382 € respectively, while the cost/effectiveness ratio was of 106,621 and 178,424 €.The incremental analysis performed shows how the use of voriconazole versus amphotericin B produces a healthcare resources saving of 406 € per patient. Conclusions: Voriconazole is more efficient than amphotericin B deoxycholate in the treatment of invasive aspergillosis, (thus)resulting in healthcare resources saving due to better clinical results with lower associated costs

Tumoración ovárica gigante de crecimiento retroperitoneal / Giant ovarian tumour, growing retroperitonealy

Se expone el caso clínico de una muchacha de 14 años que presenta una tumoración abdominal gigante, de evolución asintomática, que resultó ser un cistoadenoma seroso de ovario pero de crecimiento retroperitoneal. Se plantea como causa de esta anomalía anatómica el antecedente quirúrgico en la infancia de la corrección de una enfermedad de Hirschprung (AU)