Riesgo de contagio por COVID-19 en función del tipo de contacto y de la renta familiar / Risk of contagion by COVID-19 depending on the type of contact and family income

Introducción: tras una segunda oleada de la pandemia COVID-19 en Zaragoza, se estudian los contactos estrechos con pacientes con COVID-19, con la finalidad de valorar el riesgo de infección tras exposición en función del paciente índice, adulto o niño, y la renta familiar. Material y métodos: se realiza un estudio descriptivo de todos los pacientes pediátricos que han tenido contacto con pacientes con COVID-19 en el centro de salud de Delicias Sur de Zaragoza entre los meses de julio y agosto de 2020 y se valora la aparición de síntomas, consultas en servicio de urgencias, realización de pruebas complementarias, contacto estrecho con adulto o con niño y la renta familiar. Resultados: un total de 292 pacientes fueron contacto estrecho con pacientes con COVID-19, de los cuales 128 fueron positivos para la PCR de SARS-CoV-2. Al analizar el tipo de contacto, se encontró que un 10,94% había mantenido contacto estrecho con un niño y un 89,06% con un adulto. El riesgo de contagio tras sufrir contacto con un niño positivo fue del 34,15%, mientras que, tras contacto con un adulto positivo, el riesgo fue del 45,78%. Asimismo, el riesgo de contagio entre las rentas inferiores a 18 000 € fue de 47,9 frente al 27,6% de aquellos pacientes con rentas superiores a 18 000 €. Conclusiones: el riesgo de contagio de COVID-19 es mayor cuando el contacto estrecho es con un adulto y cuando el nivel de renta familiar es inferior (AU)

Purpose: during the second wave of the COVID-19 pandemic in Zaragoza, we studied the paediatric contacts of COVID-19-positive patients to estimate the risk of infection after exposure to a positive child or adult and the risk of infection based on household income.Methods: we conducted a descriptive study of all paediatric patients that were close contacts of individuals with COVID-19 in the Delicias Sur Primary Care Centre (Zaragoza, Spain) between July and August 2020. We also analysed the most frequent symptoms, visits to the emergency department, diagnostic tests, contact with a child versus an adult with COVID-19 and household income.Results: a total of 292 patients had had close contact with individuals with COVID-19; 218 of them had positive SARS-CoV-2 PCR test results. When we analysed the close contacts, we found that 10.94% of patients that tested positive had been in close contact with a child with COVID-19 and 89.06% with an adult with COVID-19. The estimated risk of infection after exposure was 29.8% in the case of close contact with a child with COVID-19 compared to 46.53% when it came to close contact with an adult case. The risk of infection was higher in patients with an annual household income of less than €18000 (47.9%) compared to patients with a higher annual household income (27.6%).Conclusion: the risk of SARS-CoV-2 infection was higher in patients that had close contact with adult cases and with lower household incomes. (AU)

Guías de práctica clínica y otros productos basados en la evidencia, en la consulta / Clinical Practice guides and other evidence based products in the clinic

GuíaSalud es un organismo del Sistema Nacional de Salud (SNS) en el que participa el conjunto de comunidades autónomas (CC. AA.), que cuenta con el refrendo del Consejo Interterritorial (CI) y el apoyo del Ministerio de Sanidad y Política Social a través de la Agencia de Calidad del SNS. Desde que da su primeros pasos, a mediados del año 2002, hasta la actualidad, se ha visto inmerso en cambios enmarcados en el Plan de Calidad del SNS, siendo el último, descrito en el Plan de Calidad del año 2007 el que implica un giro importante en objetivos, introduciéndose en la cartera de trabajo el desarrollo de productos basados en la evidencia científica que ayuden a los profesionales sanitarios en la toma de decisiones. Esto implica un cambio en la estructura organizativa de dirección y gestión de GuíaSalud, dedicación de recursos dirigidos a fortalecer el desarrollo de guías de práctica clínica (GPC) en nuestro país, y a abrir nuevas líneas de trabajo encaminadas a enriquecer la oferta de productos a los profesionales sanitarios, como es el caso para las preguntas clínicas. En esta estrategia se cuenta con las personas que integran el Comité Científico de GuíaSalud, su Consejo Ejecutivo (CE), y aquellos profesionales sanitarios interesados en una metodología de trabajo sistemática y explícita y que constituyen la red de colaboración de GuíaSalud. Desde la Secretaría de GuíaSalud se cuenta con un equipo de profesionales conocedores de la metodología de trabajo adecuada y una web 2.0 dirigida a interaccionar con los profesionales sanitarios (AU)

GuíaSalud is a National Health System (NHS) agency, which includes all the Autonomous Communities (CCAA), and has the endorsement of the inter-territorial council (IC) which is supported by the Ministry of Health and Social Policy through the NHS Quality Agency. Since its first steps, in mid-2002 until now, it has been immersed in framework changes within the quality of the NHS Plan. The latter being described in the quality plan of 2007, which involves important changes in the objectives, introducing into the work portfo lio the development of products, based on scientific evidence to assist health professionals in decision-making. This involves changes in the organizational structure of leadership and management of GuíaSalud, dedication of resources aimed at strengthening the development of clinical practice guidelines (CPG) in our country, and open new lines of work aimed at enrichment the offer of products to the health professionals, as is the case for clinical questions. This strategy includes professionals who are part of GuíaSalud’ s Scientific Committee, Executive Council (EC), and other health professionals interested in working with a systematic and explicit methodology; and are part of the GuíaSalud collaborative network. The GuíaSalud department has a team of professionals who know about the appropriate methodology and a web 2.0 designed to interact with health professionals (AU)

[Neuropaediatrics and primary care. Our experience in the 21st century]. / Neuropediatría y atención primaria.Nuestra experiencia en el siglo XXI.

INTRODUCTION: The quality of the health care in a major part of neuropaediatrics benefits from appropriate communication and strategies that have been agreed with primary care (PC) paediatricians. PATIENTS AND METHODS: We analyse the children who were assessed in the Neuropaediatric service at the Hospital Universitario Miguel Servet in Saragossa over a period of eight years and we also discuss the most important courses of action followed in the most prevalent problems. RESULTS: Eight reasons for visiting accounted for 86% of the total number: paroxysmal disorders (33%), headache (27%), psychomotor retardation (11.5%), alterations affecting the shape or size of the head (5.6%), problems at school and/or attention deficit (4.5%), behavioural disorders (4.25%), gait disorders (3.5%) and perinatal distress (3.4%). The most frequent diagnoses are headaches/migraines (26%), non-epileptic paroxysmal disorders (16.5%), prenatal encephalopathy (10.5%), epilepsy (8%), mental retardation (7.5%), infantile cerebral palsy (4.6%), cryptogenic attention deficit hyperactivity disorder (ADHD) (3.8%) and cryptogenic autism (3.6%). CONCLUSIONS: The PC paediatrician working in close relation with the children and their families in all cases is the person mainly responsible for conducting a follow-up on some of the most prevalent problems, such as headaches, many non-epileptic paroxysmal disorders and ADHD. The processes must be established, clearly specified, based on the best evidence, with the participation and within reach of all the professionals involved, in order to favour homogeneity and keep variability in the interventions to a minimum. Channels of communication, including the information and communications technologies, need to be set up to allow health professionals to be permanently up-to-date and capable of controlling their patients in the best possible way.

Hiponatremia por pérdida renal de sal en paciente con diabetes insípida central / Hyponatremia due to renal salt wasting in a patient with partial central diabetes insipidus

La hiponatremia en el contexto de una diabetes insípida suele corresponder a un exceso en el uso de desmopresina; sin embargo, existen otras posibilidades. Se presenta el caso de un lactante de 18 meses, remitido por un cuadro de 2 meses de evolución de poliuria, polidipsia y pérdida ponderal. Los antecedentes, exploración física y exploraciones complementarias, incluida neuroimagen, eran normales, salvo la presencia de una poliuria hiposmolar de 3 litros que, tras dieta seca y administración de hormona antidiurética (ADH), se catalogó de diabetes insípida central parcial. Se inició tratamiento con desmopresina intranasal. Seis meses más tarde, ingresó en UCI por un cuadro de deshidratación hiponatrémica grave (sodio de 108 mEq/L), convulsiones y poliuria con fracción de excreción de sodio de 3 mL/100 mL de filtrado glomerular. Un mes más tarde, presentó otro cuadro similar, por lo que se inició la administración de sal por vía oral. A los cuatro meses, la poliuria-polidipsia mejoró. Ante la mejoría clinicoanalítica, se suspendió el tratamiento. El paciente permanece asintomático un año más tarde. El síndrome cerebral pierde sal se caracteriza por diuresis y natriuresis elevadas, hiponatremia y depleción del espacio extravascular. En su patogénesis, se baraja la acción de distintos péptidos natriuréticos; su desencadenante no es siempre una enfermedad intracraneal. En el caso descrito, se dudó de si se trataba de una verdadera diabetes insípida central parcial transitoria o bien de una polidipsia-poliuria primaria que desarrolló, posteriormente, un síndrome pierde sal por desajuste en el eje ADH-péptidos natriuréticos

Hyponatremia in association with diabetes insipidus usually corresponds to an overdose of desmopressin; nevertheless, there are other possibilities. We present the case of an 18-month-old boy who was referred to us with a 2-month history of polyuria, polydipsia and weight loss. His medical record and the results of physical examination and additional tests, including neuroimaging, were normal, except for the presence of hypo-osmolar polyuria (3 L). After dry diet and the administration of antidiuretic hormone (ADH), he was diagnosed as having partial central diabetes insipidus, and intranasal desmopressin therapy was begun. Six months later, he was admitted to the intensive care unit with severe dehydration associated with hyponatremia (Na: 108 mEq/L), seizures and polyuria, with fractional excretion of sodium of 3 mL/100 mL glomerular filtration rate (GFR). One month later, he presented a similar episode and oral salt supplementation was begun. Four months later, his polyuria and polydipsia had improved. Given the clinical and analytical improvement, the treatment was discontinued and the child remains asymptomatic one year later. Cerebral salt-wasting syndrome is characterized by marked diuresis and natriuresis, in the presence of hyponatremia and depletion of the extravascular space. Its pathogenesis has been attributed to the action of different natriuretic peptides, and it is not always triggered by an intracranial disease. In our case, we questioned whether the patient presented true transient partial central diabetes insipidus or, in contrast, primary polydipsia-polyuria with subsequent development of salt-wasting syndrome due to an imbalance in the ADH-natriuretic peptide axis

[Immunity to measles, mumps and rubella in children vaccinated with triple viral vaccine]. / Inmunidad frente a sarampión, rubéola y parotiditis en niños vacunados con la triple vírica.

OBJECTIVE: To check up on measles-mumps-rubella immunity in children vaccinated with MMR vaccine. DESIGN: A descriptive cross-sectional study trough seroepidemiological survey. SETTING: Oliver-Miralbueno Health Centre, Zaragoza. PATIENTS: 92 healthy children of 5, 7 and 9 years of age who went for clinical preventive services. All of them vaccinated with MMR at the age of 15 to 18 months. None of them had suffered from measles, mumps or rubella. MEASUREMENTS AND MAIN RESULTS: 1) The percentage of seronegative children (title less than 1:8) was: 9.8% for measles, 8.7% for rubella, and 27.2% for mumps. 2) As to the time differences among seropositive and seronegative children. CONCLUSIONS: The study reveals that there is a high percentage of MMR vaccinated children showing minimal or undetectable levels of antibodies.