Impact of an influenza vaccine educational programme on healthcare personnel.

Influenza vaccination has been shown to be the most effective preventive strategy to reduce influenza-related morbidity and mortality in high-risk groups. Despite healthcare personnel (HCP) being considered part of such high-risk groups, their vaccination coverage is low in Europe. In January 2012, we distributed an 18-question survey regarding influenza vaccination to HCP at Gregorio Marañon Paediatric Hospital, in Madrid, Spain. After we documented that only ~30% of HCP were vaccinated an educational programme was implemented in October 2012 before the next influenza season. In January 2013, the same survey delivered again to all HCP documented a significant increase in vaccination rates (from 30% to 40%, P = 0·007) mainly among physicians and for patients' protection. In summary we found that a simple and inexpensive educational programme significantly improved the uptake of influenza vaccination in HCP in our centre. Nevertheless, vaccination rates remained low, and broader and updated campaigns are needed to overcome perception barriers.

Pólipo antropilórico en la enfermead de Menkes / Antropyloric polyp in Menkes disease

Presentamos el caso de un lactante diagnosticado de enfermedad de Menkes en tratamiento sustitutivo con cobrehitidina que presentó un cuadro de pseudoobstrucción instestinal con hemorragia digestiva alta. La aparición de pólipos gastrointestinales por hiperplasia mucosa en la enfermedad de Menkes puede asociar importante morbimortalidad y no se previenen con el tratamiento enzimático, precisando resección endoscópica o quirúrgica (AU)

We present a case of an infant with Menkes disease treated with copper-histidine replacement therapy who developed an intestinal pseudo-obstruction with upper gastrointestinal mucosa and polyps is related to significant morbidity in Menkes disease. We can not prevent them with enzyme treatment so it usually need endoscopic or surgical resection (AU)

Evaluación del riesgo de fenómenos trombóticos tras el uso de factor VII activado / Risk assessment of thrombotic events after the use of activated factor VII

Introducción: El objetivo del estudio fue analizar la incidencia de efectos trombóticos relacionada con la administración de factor VII humano recombinante activo (rFVIIa) en el tratamiento de la hemorragia grave tras la cirugía cardiaca. Material y métodos: Estudio retrospectivo de casos-controles pareado, de 2 años de duración, que incluyó a 72 niños ingresados en cuidados intensivos y tratados con rFVIIa por una hemorragia grave, durante o tras la cirugía cardiaca. Utilizamos un grupo control de 63 pacientes, estadísticamente comparables en cuanto a sexo, peso, diagnóstico, riesgo quirúrgico según la clasificación RACHS-1 y las características quirúrgicas. Resultados: No existieron diferencias significativas en la incidencia de fenómenos trombóticos (20% en casos y 28% en controles, p = 0,540), ni en la mortalidad (16% en casos y 9,5% controles, p = 0,208). Conclusión: En nuestra serie, el tratamiento con rFVIIa ha demostrado ser útil en el control de la hemorragia incoercible en niños sometidos a cirugía cardiaca, y no parece aumentar el riesgo de fenómenos trombóticos ni la mortalidad en el periodo postoperatorio (AU)

Introduction: The objective of this study was to analyze the incidence of thrombotic complications related to recombinant human factor VII a (rFVIIa) therapy for severe postoperative bleeding in cardiac surgery. Material and methods: A retrospective matched case-control study was conducted over two years, including 72 children admitted to intensive care unit and treated with rFVIIa because of a severe bleeding during or after cardiac surgery. A control group of 63 patients was chosen, who were statistically comparable in sex, weight, diagnosis, surgical risk according RASCH-1 score, and surgical characteristics, was chosen. Results: There were no significant differences between cases and controls either in the rate of thrombosis (20% vs 28%, P=0.540), or in the mortality rate (16% vs 9.5%, P=0.208). Conclusions: In our study, the rFVIIa therapy was shown to be useful in controlling severe operative bleeding in pediatric cardiac surgery, but does not seem to increase the risk of thrombotic complications or mortality rate in the postoperative period (AU)

Resistencia a hormonas tiroideas y trastorno por déficit de atención e hiperactividad / Resistance to thyroid hormone and attention deficit hyperactivity disorder

No disponible

[Risk assessment of thrombotic events after the use of activated factor VII]. / Evaluación del riesgo de fenómenos trombóticos tras el uso de factor vii activado.

INTRODUCTION: The objective of this study was to analyze the incidence of thrombotic complications related to recombinant human factor viia (rFVIIa) therapy for severe postoperative bleeding in cardiac surgery. MATERIAL AND METHODS: A retrospective matched case-control study was conducted over two years, including 72 children admitted to intensive care unit and treated with rFVIIa because of a severe bleeding during or after cardiac surgery. A control group of 63 patients was chosen, who were statistically comparable in sex, weight, diagnosis, surgical risk according RASCH-1 score, and surgical characteristics, was chosen. RESULTS: There were no significant differences between cases and controls either in the rate of thrombosis (20% vs 28%, P=.540), or in the mortality rate (16% vs 9.5%, P=.208). CONCLUSIONS: In our study, the rFVIIa therapy was shown to be useful in controlling severe operative bleeding in pediatric cardiac surgery, but does not seem to increase the risk of thrombotic complications or mortality rate in the postoperative period.

Dermatitis artefacta / Dermatitis artefacta

La dermatitis artefacta (DA) es un trastorno facticio con predominio de signos y síntomas de tipo dermatológico. Las lesiones cutáneas suelen ser muy variables, en función del método empleado y de la imaginación de quienes las producen, aunque existen ciertas características comunes. Su diagnóstico es difícil: hay que excluir las enfermedades físicas verdaderas y se basa en la morfología de las lesiones y en los rasgos de personalidad del paciente. El tratamiento también es complicado; es importante identificar de forma precoz el trastorno y tratar la patología psiquiátrica existente. Presentamos el caso de un niño con un cuadro de DA en forma de lesiones purpúricas (AU)

Dermatitis artefacta (DA) is a factitious disorder in which dermatological signs and symptoms are the predominant feature. Skin lesions are very variable, depending on the methods they choose to use and the imagination of their perpetrators but there are some common characteristics. Its diagnosis is difficult, and it can only be made after excluding real physical illness, based on the morphology of the lesions and the patient’s personality characteristics. The treatment is also complicated but it is important to identify the disorder in an early stage and to treat the underlying psychiatric disorders (AU)

Bronquiectasias en pacientes sin fibrosis quística / Bronchiectasis in patients without cystic fibrosis

Presentamos un caso de neumonías de repetición en la misma localización en una niña de 9 años con tos productiva prácticamente diaria. La prueba del sudor fue negativa y la TC de tórax evidenció bronquiectasias localizadas. Las bronquiectasias son la secuela final de un proceso crónico originado por múltiples causas, la mayoría de ellas adquiridas. Aunque su frecuencia se ha reducido en los últimos años, hay que pensar en ellas ante la cronificación y/o recurrencia de algunas patologías respiratorias. Se analiza su etiología, sus síntomas y signos más frecuentes, así como las pruebas complementarias a realizar. El manejo ideal es el específico de la causa subyacente aunque en pocos casos es posible. Se insiste en el tratamiento médico intensivo, reservándose la cirugía en caso de mala respuesta al mismo (AU)

We present a case of repeated pneumonias in the same location in a 9-year old girl with almost daily productive cough. The sweat test was negative and the chest CT scan showed localized bronchiectasis. Bronchiectases are the final sequel of a chronic process originated by multiple causes, most of them acquired. Although their frequency has decreased in recent years, they must be considered when the condition becomes chronic and/or there is recurrence of some respiratory conditions. An analysis is made of its etiology, most frequent symptoms and signs and the complementary test to be conducted. The ideal management is that specific to the underying cause although this is only possible in a few cases. The need for intensive medical treatment is stressed, reserving surgery for when there is poor response to it (AU)