[Activity of a short-stay observation unit in an emergency department of a tertiary hospital. A two-year experience]. / Actividad de una unidad de observación en un servicio de urgencias de un hospital terciario: dos años de experiencia.

OBJECTIVES: To describe the characteristics of the activity of a short stay observation unit (SSOU) in a tertiary hospital, and to analyze its influence on the hospitalization rate. MATERIAL AND METHODS: The activity of the SSOU during the first 2 years after opening is described. Descriptive variables were registered. Hospitalization activity during the first 5 months after opening the unit was compared with the activity during the same period in the previous year. RESULTS: From June 1, 2001 to May 31, 2003, 74,989 patients were admitted to the emergency department (ED) and 2,438 (3.25 %) were transferred to the SSOU. The mean age of the patients was 64.55 months. The mean length of stay was 5 hours and 50 minutes. The main discharge diagnoses were gastrointestinal disease (30.2 %), accidents (15 %), respiratory illness (12.5 %) and febrile syndrome (9.8 %). The hospitalization rate in patients admitted to the ED was 5.8 % from June 1, 2000 to October 1, 2000 and was 4.28 % in the same period in 2001. The mean diagnosis-related group (DRG)-weight was 0.8648 in 2000 and was 0.9078 in 2001. Total weight was 680.66 in 2000 and 495.69 in 2001, allowing an approximate saving of 329,162 Euros. CONCLUSIONS: The opening of the SSOU has been useful in the assessment and treatment of common childhood diseases and has helped reduce the hospitalization rate, increase the complexity of inpatients and lower costs.

[Transglutaminase antibody: usefulness in the diagnosis of celiac disease]. / Anticuerpo antitransglutaminasa: utilidad en el diagnóstico de la enfermedad celíaca.

AIM: Until now IgA-EmA and IgA-AGA antibodies have been considered to be specific and sensitive markers of celiac disease. Anew antibody, the tissue transglutaminase (IgA-tTG), antibody has recently been identified, which is believed to be if not a better marker then a more practical one in screening for celiac disease, especially in large populations. To evaluate the usefulness of the IgA-tTG antibody in the diagnosis and screening of celiac disease and to determine the relationship between this antibody and other better known and over-used antibodies, antigliadin (IgA-AGA) and antiendomysial (IgA-EmA). PATIENTS AND METHODS: The study was performed in 115 children divided into three groups: 31 patients diagnosed with the celiac disease, according to the ESPGAN criteria; 21 patients with celiac disease following a gluten free diet, and 63 considered as control group. Two enzyme linked immunoabsorbent assays (ELISA) were used to detect AGA and tTG antibodies, respectively. EmA antibodies were determined by using an indirect immunofluorescence technique with commercial sections of distal monkey oesophagus as antigen. RESULTS: In the 115 patients taken as a whole, the tTG antibody showed 91% agreement with the EmA antibody and 85% agreement with the AGA antibody. In the celiac group, agreement was 84% and 61% respectively. Sensitivity of the tTG antibody was 83% compared with 94% for EmA and 74% for AGA. Specificity was similar in all three tests. CONCLUSIONS: The ELISA test for tTG correlates well with the traditional AGA and EmA tests and could be used as a new test for celiac disease. The procedure is simple and shows high specificity and sensitivity compared with classical EmA and AGA tests and does not involve subjective scoring. It is cheap and very well suited for large scale screening for celiac disease.

[Infant mortality and sudden infant death in Navarra between 1985 and 1996]. / Mortalidad infantil y mortalidad por muerte súbita infantil en Navarra 1985-1996.

OBJECTIVE: The objective of this study was to obtain an accurate register of the deaths of children less than one year of age in order to discover the real infant mortality (IM) rate in Navara and its trend during the period between 1985 and 1996, a well as to investigate the deaths by sudden infant death (SID) in the same period and their relationship to the prone position during sleep. PATIENTS AND METHODS: Infant mortality was determined by detailed examination of all certified deaths. Research into possible nonregistered deaths was also carried-out. The sources of information included the archives and registers of the pediatric and obstetric wards and pathology departments of all hospitals. Deaths codified as 798.0 (CIE9 infinity R) were included in the study as death by SID. To determine sleeping posture. In the second semester of 1996, a survey was carried out on a sample of 285 children of under 6 months of age. The survey's model is the same as that published previously. RESULTS: In the period of 1985 to 1992, IM was 12.33 per thousand live births. The SID rate was 1.30/1,000 live births. The prevalence of the prone position is unknown. In the period between 1993 and 1996, IM decreased to 5.84/1,000 live births and this decrease was proportional in both the neonatal and postneonatal components. The rate of SIM decreased to 0.44/1,000 live births. At the beginning of 1993, 86% of the children slept in the prone position, in 1994, 38% and in 1996, only 23%. CONCLUSIONS: Trustworthy data in Navarra shows a decrease in IM of more than 50% from 1993 on. The SID rate also decreased by 65%, coinciding with a massive drop in the use of the prone position during sleep.

Water, fat, nitrogen, and sugar content in feces: reference intervals in children.

Malabsorption-maldigestion syndromes are commonly found in several gastrointestinal diseases. Quantitative measures of fecal nutrients are important tools for the detection and diagnosis of these syndromes. Adequate food intake is important in the nutrition of children, especially during the first year of life. We have analyzed 180 stools of healthy children, divided into four age groups, to obtain the reference intervals of the major nutrients such as water, fat, nitrogen, sugar, and starch. Quantification of the nutrients was done by means of a near-infrared analyzer (Fenir 8820). Results show that this instrument exhibits a low coefficient of variation for all the nutrients except for starch. Fecal water, fat, nitrogen, and sugar concentrations ranged from 68.7 to 96.1 g/100 g, 0 to 14.5 g/100 g, 1.3 to 2.3 g/100 g, and 0.7 to 3.8 g/100 g, respectively. The results for the starch analyses were not acceptable because of instrument limitations. Near-infrared reflectance spectroscopy appears to be an alternative to standard chemical methods.

[Change of position and the decrease in the cases of sudden infant death syndrome in Navarra]. / Cambio de postura y disminución de la tasa de mortalidad por muerte súbita infantil en Navarra.

The prone position during sleep has been described as the most important risk factor in relationship to sudden infant death syndrome (SIDS). The prevalence of infants that sleep in the prone position and its relationship with SIDS has not been studied in our country. A survey was performed in a population of children born in Navarra between February 1, 1992 and February 1, 1993. We found that 86.5% of these children sleep in the prone position, 5.6% in the supine position and 3.5% on their side. In March 1993 a campaign was begun that recommended that the prone position not be used for infants from the time of birth until 6 months of age. After this campaign, in a sample of 441 children, born between May 1, 1993 and May 1, 1994, only 38.3% of the infants continued to sleep in the prone position, while 46% did so supine and 9% slept on their side. The number of deaths in Navarra as a result of SIDS during the period of 1985 through 1993 was 1.3% of live births with a mean of 6.3 deaths/year. The number of infant deaths after the change of sleeping position, in 1994, was 0.42% of live births, with 2 deaths as a result of SIDS during this year. In Navarra, the decrease in the number of infants sleeping in the prone position has been accompanied by a significant decline in the number of deaths due to SIDS.