Resultados tras implantación de un protocolo de sedoanalgesia para procedimientos en ámbito hospitalario / Results after implementation of a sedoanalgesia protocol for procedures in hospital environment

INTRODUCCIÓN: Se analiza la efectividad y seguridad de un protocolo específico de sedoanalgesia para procedimien tos, y evalúa la satisfacción del personal sanitario con cada procedimiento. PACIENTES Y MÉTODO: Estudio prospectivo de un protocolo de sedoanalgesia para procedimientos en ámbito hospitalario en menores de 18 años, con una estrategia individualizada según la situación basal del paciente, el tipo de procedimiento y la experiencia del pediatra responsable de la sedación. Se registraron las variables: diagnóstico que motiva el procedimiento, tipo de procedimiento, datos antropométri cos, alergias, medicación, estado ASA y enfermedad de base, tiempo de ayuno, auscultación pul monar, temperatura, saturación de oxígeno, frecuencia respiratoria, frecuencia cardiaca, tensión arterial, lugar de sedación, tipo de fármaco, dosis, tipo de vía, escala de sedación Ramsay, duración de la sedación, tipo y tratamiento de efectos adversos, presencia de familiares durante todo el pro cedimiento y satisfacción del paciente. RESULTADOS: Se realizaron 279 sedaciones. Los fármacos más usados fueron óxido nitroso (62,7%) y midazolam (16,5%); las vías de administración más utili zadas fueron la inhalada (62,4%) y la intravenosa (15,8%). La satisfacción fue alta para el pediatra (92,5%), el enfermero (94,3%), los familiares (96,8%) y los pacientes (93,6%), con una buena correlación entre ellos, y fue significativamente menor al usar midazolam y las vías nasal y bucal. La tasa de efectos adversos fue del 3,2%, y ninguno fue grave. CONCLUSIONES: La implementación de un protocolo específico de sedoanalgesia para procedimientos en el ámbito hospitalario consigue una alta efectividad y seguridad, además de un alto nivel de satisfacción, tanto en familiares como en personal sanitario.

INTRODUCTION: We analyze the effectiveness and safety of a specific analgosedation protocol for procedures, and eva luate the satisfaction of the health personnel with each procedure. PATIENTS AND METHOD: Prospective study of an analgosedation protocol for hospital procedures in children under 18 years of age, with an individualized strategy based on the patient's baseline situation, the type of procedure and the experience of the pediatrician responsible for the sedation. The following variables were recorded: diagnosis motivating the procedure, type of procedure, anthropometric data, allergies, medication, ASA status and baseline disease, fasting time, lung auscultation, temperature, oxygen saturation, res piratory rate, heart rate, blood pressure, sedation location, type of drug, dose, route of administra tion, Ramsay sedation scale, duration of sedation, type and treatment of adverse effects, presence of family members throughout the procedure, and patient satisfaction. RESULTS: 279 sedations were performed. The most commonly used drugs were nitrous oxide (62.7%) and midazolam (16.5%); the most commonly used routes of administration were the inhaled one (62.4%) and the intravenous one (15.8%). The satisfaction was high for the pediatrician (92.5%), the nurse (94.3%), the family (96.8%), and patients (93.6%), with a good correlation between them, and it was significantly lower when using midazolam and the nasal and oral routes. The adverse effects rate was 3.2%, and none was severe. CONCLUSIONS: The implementation of a specific analgosedation protocol for procedures in the hospital environment achieves high levels of effectiveness and safety, as well as a high level of satisfaction, both in family members and in health personnel.

Results after implementation of a sedoanalgesia protocol for procedures in hospital environment. / Resultados tras implantación de un protocolo de sedoanalgesia para procedimientos en ámbito hospitalario.

INTRODUCTION: We analyze the effectiveness and safety of a specific analgosedation protocol for procedures, and eva luate the satisfaction of the health personnel with each procedure. PATIENTS AND METHOD: Prospective study of an analgosedation protocol for hospital procedures in children under 18 years of age, with an individualized strategy based on the patient's baseline situation, the type of procedure and the experience of the pediatrician responsible for the sedation. The following variables were recorded: diagnosis motivating the procedure, type of procedure, anthropometric data, allergies, medication, ASA status and baseline disease, fasting time, lung auscultation, temperature, oxygen saturation, res piratory rate, heart rate, blood pressure, sedation location, type of drug, dose, route of administra tion, Ramsay sedation scale, duration of sedation, type and treatment of adverse effects, presence of family members throughout the procedure, and patient satisfaction. RESULTS: 279 sedations were performed. The most commonly used drugs were nitrous oxide (62.7%) and midazolam (16.5%); the most commonly used routes of administration were the inhaled one (62.4%) and the intravenous one (15.8%). The satisfaction was high for the pediatrician (92.5%), the nurse (94.3%), the family (96.8%), and patients (93.6%), with a good correlation between them, and it was significantly lower when using midazolam and the nasal and oral routes. The adverse effects rate was 3.2%, and none was severe. CONCLUSIONS: The implementation of a specific analgosedation protocol for procedures in the hospital environment achieves high levels of effectiveness and safety, as well as a high level of satisfaction, both in family members and in health personnel.

How molecular diagnosis may modify immunotherapy prescription in multi-sensitized pollen-allergic children

INTRODUCTION: Specific immunotherapy (SIT) is used to treat asthma and allergic rhinitis, and a dose-response relationship has been found for SIT efficacy, creating a need to accurately select the allergen used in therapy. This need is especially pronounced in poly-sensitized children living in areas where different pollen allergen sources coexist in the same season, as this circumstance complicates diagnostic efforts. In such cases, component-resolved diagnosis (CRD) can increase diagnostic accuracy and aid in SIT prescription. MATERIALS AND METHODS: We hypothesized that CRD results would lead to modifications in classical immunotherapy prescription based on sources such as medical history, season of symptom presentation, and skin testing. We studied a sample of children indicated for immunotherapy in whom classical methods had not pointed out the most relevant allergen due to sensitization to more than two pollens. We used a small panel of recombinant allergens, analyzing the percentage of changes to prescription considering the findings of molecular studies. RESULTS: Of the 70 children included, CRD led to modified immunotherapy prescription in 54.3%. Indications of single-allergen therapy increased from 18% to 51% when CRD was included. The decision to prescribe immunotherapy was reversed following CRD in 9.3% of cases. DISCUSSION: CRD use alters the choice of specific immunotherapy in poly-sensitized children. A wide panel of recombinant allergens may not be necessary to improve immunotherapy indication using molecular techniques; rather, a smaller panel adapted to include those allergens prevalent in the geographical area in question appears to be sufficient for more effective immunotherapy, also leading to an improved cost-benefit ratio

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How molecular diagnosis may modify immunotherapy prescription in multi-sensitized pollen-allergic children.

INTRODUCTION: Specific immunotherapy (SIT) is used to treat asthma and allergic rhinitis, and a dose-response relationship has been found for SIT efficacy, creating a need to accurately select the allergen used in therapy. This need is especially pronounced in poly-sensitized children living in areas where different pollen allergen sources coexist in the same season, as this circumstance complicates diagnostic efforts. In such cases, component-resolved diagnosis (CRD) can increase diagnostic accuracy and aid in SIT prescription. MATERIALS AND METHODS: We hypothesized that CRD results would lead to modifications in classical immunotherapy prescription based on sources such as medical history, season of symptom presentation, and skin testing. We studied a sample of children indicated for immunotherapy in whom classical methods had not pointed out the most relevant allergen due to sensitization to more than two pollens. We used a small panel of recombinant allergens, analyzing the percentage of changes to prescription considering the findings of molecular studies. RESULTS: Of the 70 children included, CRD led to modified immunotherapy prescription in 54.3%. Indications of single-allergen therapy increased from 18% to 51% when CRD was included. The decision to prescribe immunotherapy was reversed following CRD in 9.3% of cases. DISCUSSION: CRD use alters the choice of specific immunotherapy in poly-sensitized children. A wide panel of recombinant allergens may not be necessary to improve immunotherapy indication using molecular techniques; rather, a smaller panel adapted to include those allergens prevalent in the geographical area in question appears to be sufficient for more effective immunotherapy, also leading to an improved cost-benefit ratio.

Manifestaciones pulmonares en la neurofibromatosis tipo 1: una asociación a tener en cuenta / Pulmonary manifestation in neurofibromatosis type 1, an association to be considered

La neurofibromatosis tipo 1 es la enfermedad neurocutánea más frecuente. Es un trastorno genético con herencia autosómica dominante que produce alteraciones principalmente en la piel y en el sistema nervioso, pero también en otros órganos. La afectación pulmonar en pacientes con neurofibromatosis se ha descrito como una complicación rara que aparece principalmente en adultos. Presentamos el caso de un adolescente no fumador con neurofibromatosis tipo 1 y manifestaciones pulmonares asociadas (AU)

Neurofibromatosis type 1 is the most common neurocutaneous disease. It is a genetic disorder inherited as an autosomal-dominant trait, which leads to abnormalities mainly in the skin and in the nervous system, but also in other organs. Pulmonary involvement in patients with neurofibromatosis has been described as a rare complication, which mainly affects adults. We report the case of a non-smoker adolescent male with neurofibromatosis type 1 and associated pulmonary manifestations (AU)

Enfermedad hemorrágica del recién nacido tras parto domiciliario / Haemorrhagic disease of the newborn after home delivery

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Broncocele como imagen radiológica persistente / Bronchocele as a persistent radiological image

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Absence of clinical symptoms upon introduction of egg into the diet of milk-allergic infants not previously sensitised to egg

Background: It is unclear how many children suffering from IgE mediated cow's milk allergy are sensitised to egg in early life and what the clinical implication of this sensitisation is. It is also unclear if those not sensitised to egg in early life, do later on develop sensitisation and clinical allergy to egg. Methods: This study examines the prevalence of egg sensitisation among infants with allergy to cow's milk, prior to and following the introduction of egg and what this sensitisation clinically means. Results: The percentage of egg-sensitised children seen among the group of children with cow's milk allergy was 43.2%, and predictive factors for egg sensitisation are discussed. 81.8% of the sensitised patients presented with symptoms when exposed to egg in at least one of its forms, although up to 54.5% of patients tolerated boiled egg and egg-based products. Of the non-sensitised patients, the vast majority (92.5%) did not present with symptoms after the introduction of egg in their diet. Conclusions: Coexistence of allergy to egg and milk allergy is common, and it is recommended that these patients be monitored, since children who are sensitised to egg despite having never been exposed to it in their diet, may present with symptoms immediately following first ingestion. Most children who are initially non-sensitised to egg do not require special care, and it is not generally recommended to delay or monitor these children, although a small number may have subsequently reacted to egg(AU)

Absence of clinical symptoms upon introduction of egg into the diet of milk-allergic infants not previously sensitised to egg.

BACKGROUND: It is unclear how many children suffering from IgE mediated cow's milk allergy are sensitised to egg in early life and what the clinical implication of this sensitisation is. It is also unclear if those not sensitised to egg in early life, do later on develop sensitisation and clinical allergy to egg. METHODS: This study examines the prevalence of egg sensitisation among infants with allergy to cow's milk, prior to and following the introduction of egg and what this sensitisation clinically means. RESULTS: The percentage of egg-sensitised children seen among the group of children with cow's milk allergy was 43.2%, and predictive factors for egg sensitisation are discussed. 81.8% of the sensitised patients presented with symptoms when exposed to egg in at least one of its forms, although up to 54.5% of patients tolerated boiled egg and egg-based products. Of the non-sensitised patients, the vast majority (92.5%) did not present with symptoms after the introduction of egg in their diet. CONCLUSIONS: Coexistence of allergy to egg and milk allergy is common, and it is recommended that these patients be monitored, since children who are sensitised to egg despite having never been exposed to it in their diet, may present with symptoms immediately following first ingestion. Most children who are initially non-sensitised to egg do not require special care, and it is not generally recommended to delay or monitor these children, although a small number may have subsequently reacted to egg.

Correlates of species richness in the largest Neotropical amphibian radiation.

Although tropical environments are often considered biodiversity hotspots, it is precisely in such environments where least is known about the factors that drive species richness. Here, we use phylogenetic comparative analyses to study correlates of species richness for the largest Neotropical amphibian radiation: New World direct-developing frogs. Clade-age and species richness were nonsignificantly, negatively correlated, suggesting that clade age alone does not explain among-clade variation in species richness. A combination of ecological and morphological traits explained 65% of the variance in species richness. A more vascularized ventral skin, the ability to colonize high-altitude ranges, encompassing a large variety of vegetation types, correlated significantly with species richness, whereas larger body size was marginally correlated with species richness. Hence, whereas high-altitude ranges play a role in shaping clade diversity in the Neotropics, intrinsic factors, such as skin structures and possibly body size, might ultimately determine which clades are more speciose than others.

Fractura de pene. Revisión de la literatura y presentación de dos casos / Fracture of the penis. Literature review and contribution of two cases

Presentamos dos casos de una patología poco frecuente como es la rotura de cuerpo cavernoso de pene, sometidos a tratamiento quirúrgico precoz con buenos resultados. Revisamos así mismo, los aspectos etiológicos, clínicos, diagnósticos y el tratamiento más apropiado (AU)

[Cystic ureteritis: importance of chronic infection-inflammation as etiologic factor. Report of a clinical case]. / Ureteritis quística: importancia de la infección-inflamación crónica como factor etiológico. Aportación de un caso clínico.

Cystic Ureteritis is a very rare disease. It is more commun in elderly patients. This pathology is characterized by the formation of several submucous cystic in ureter, pelvis and/or bladder. We project the importance of the infectious and inflammatory factors as the disease etiology. We report a case of a woman with recurrent urinary tract infection, coral lithiasis and left ureteritis cystica. It is included a literature review and we explain the main clinical, diagnostic and therapeutic aspects.

[Giant inguinoscrotal bladder hernia]. / Hernia vesical inguinoescrotal gigante.

Inguinoscrotal bladder hernia occur in 0.4 to 3% of general poblation, though massive hernia are much rare. We present a new case of a giant inguinoscrotal bladder hernia, which was solved by surgery. It includes a clinical, diagnostic and therapeutic aspects, and a review of the relative literature.

Ureteritis quística: importancia de la infección-inflamación crónica como factor etiológico. Aportación de un caso clínico / Cystiic ureteritis: the importance of the cronic infection-inflammation as an etiologic factor. A case is reported

La Ureteritis Quística es una enfermedad poco frecuente, característica de la edad adulta, en la que se producen múltiples quistes en el interior del uréter, pelvis y/o vejiga, recubiertos por el urotelio. Resaltamos la importancia del factor infeccioso-inflamatorio como causa de la enfermedad. Presentamos un caso clínico de una mujer con infecciones urinarias de repetición, litiasis coraliforme y ureteritis quística izquierdas. Realizamos una revisión de la literatura, comentando los principales aspectos clínicos, diagnósticos y terapéuticos (AU)

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Hernia vesical inguinoescrotal gigante / Giant inguinoscrotal bladder hernia

La hernia vesical inguinoescrotal acontece con una frecuencia de 0,4-3 por ciento, aunque la hernia vesical masiva sí es una entidad muy rara.Presentamos un caso de hernia vesical inguinoescrotal gigante que fue resuelto mediante tratamiento quirúrgico.Se realiza una revisión de los aspectos clínicos, diagnósticos y terapéuticos, y una revisión de la literatura al respecto. (AU)

[Fracture of the penis. Review of the literature and presentation of 2 cases]. / Fractura de pene. Revisión de la literatura y presentación de dos casos.

We report two cases of a very uncommon pathology as is the rupture of the corpus cavernosum of the penis, undergoing early surgical management with good results. We also review the diagnostic, clinical and etiological aspects, and the most appropriate treatment.

[A congenital diverticulum of the bulbar urethra]. / Divertículo de uretra bulbar congénito.

OBJECTIVE: To describe an additional case of congenital bulbous urethra. The incidence, etiopathogenesis, symptoms, diagnosis and treatment of this condition are discussed. METHODS: A 16-year-old male consulted at the emergency services for urinary retention and a perineal lesion. Patient evaluation included ultrasound, retrograde and voiding urethrocystography. Treatment was by open surgery. RESULTS: The patient was evaluated at 3, 6 and 12 months. He remains asymptomatic and control urethrograms are normal. CONCLUSIONS: Open surgery is advocated as the treatment of choice for symptomatic diverticulum of a considerable size.

[Hemangioma of the glans penis]. / Hemangioma de glande.

The haemangiomas are benign vascular tumors of frequent apparition in infant, but not very much described in penis glans in the literature. We present a case with location in penis glans, in a short age male, that it was treated through conventional surgery with good results. We accomplish a review of this pathology and we make reference to the different ways of treatment today.