Impacto de la estimulación subtalámica a largo plazo sobre la situación cognitiva de los pacientes con enfermedad de Parkinson avanzada / Long-term impact of subthalamic stimulation on cognitive function in patients with advanced Parkinson's disease

OBJETIVO: El objetivo es evaluar los efectos de la estimulación cerebral profunda del núcleo subtalámico bilateral (STN-DBS) sobre el estado cognitivo de los pacientes con enfermedad de Parkinson 5 años después de la cirugía. Materiales y métodos: En este estudio prospectivo se incluyeron 50 pacientes con enfermedad de Parkinson (62,5% hombres, edad media 62,2 ± 8,2 años y duración de la enfermedad 14,1 ± 6,3 años) sometidos a STN-DBS. Todos los pacientes fueron evaluados preoperatoriamente y un año después de la cirugía, y 40 pacientes fueron seguidos hasta 5 años. En cada visita se realizaron las siguientes evaluaciones neuropsicológicas: Mini-Mental State Examination, Mattis Dementia Rating Scale (MDRS), test de secuencias números-letras de WAIS III-LN, Prueba de dibujo de reloj, Prueba de aprendizaje verbal auditivo Rey, la Prueba de retención visual de Benton, la Prueba de juicio de orientación de línea de Benton, la fluidez verbal fonética y semántica, la Prueba Stroop y la Escala de clasificación de depresión de Montgomery-Asberg. RESULTADOS: Anualmente se observaron reducciones en la puntación de Mini-Mental State Examination (-0,89%), Prueba del dibujo de reloj (-2,61%) y MDRS (-1,72%), fueron más marcados tanto para la fluidez verbal fonética (-13,28%) como semántica (-12,40%). Para la Prueba de aprendizaje verbal auditivo Rey observamos un deterioro en la capacidad de recuerdo diferido (-10,12%) un año después de la cirugía. A los 5 años la mayor parte del deterioro se produjo en la fluidez verbal, con reducciones adicionales de 16,10% y 16,60% para la fluidez verbal semántica y fonética, respectivamente. Se observó un empeoramiento más moderado del recuerdo inmediato (-16,87%), WAIS III-LN (-16,67%) y de la prueba de orientación lineal de Benton (-11,56%). Discusión: La STN-DBS no condujo a deterioro cognitivo global a los 5 años de la cirugía. Hubo un deterioro significativo en la función verbal desde el primer año de la cirugía. El deterioro de la capacidad de aprendizaje y de las funciones visuoespaciales podría atribuirse al propio proceso degenerativo de la enfermedad

OBJECTIVE: The aim of this study was to evaluate the effects of deep brain stimulation of the subthalamic nucleus (DBS-SN) on cognitive function in patients with Parkinson's disease (PD) 5 years after surgery. MATERIAL AND METHODS: We conducted a prospective study including 50 patients with PD who underwent DBS-SN (62.5% were men; mean age of 62.2 ± 8.2 years; mean progression time of 14.1 ± 6.3 years). All patients were assessed before the procedure and at one year after surgery; 40 patients were further followed up until the 5-year mark. Follow-up assessments included the following neuropsychological tests: Mini-Mental State Examination (MMSE), Mattis Dementia Rating Scale (MDRS), letter-number sequencing of the WAIS-III (WAIS-III-LN), clock-drawing test, Rey auditory verbal learning test (RAVLT), Benton Visual Retention Test (BVRT), Judgment of Line Orientation (JLO) test, FAS Phonemic Verbal Fluency Test, Stroop test, and the Montgomery-Asberg Depression Rating Scale (MADRS). RESULTS: Patients were found to score lower on the MMSE (-0.89%), clock-drawing test (-2.61%), MDRS (-1.72%), and especially phonemic (-13.28%) and sematic verbal fluency tests (-12.40%) at one year after surgery. Delayed recall on the RAVLT worsened one year after the procedure (-10.12%). At 5 years, impairment affected mainly verbal fluency; scores decreased an additional 16.10% and 16.60% in semantic and phonemic verbal fluency, respectively. Moderate decreases were observed in immediate recall (-16.87%), WAIS-III-LN (-16.67%), and JLO test (-11.56%). Discussion: In our sample, DBS-SN did not result in global cognitive impairment 5 years after surgery. Verbal function was found to be significantly impaired one year after the procedure. Impaired learning and visuospatial function may be attributed to degeneration associated with PD

Long-term impact of subthalamic stimulation on cognitive function in patients with advanced Parkinson's disease. / Impacto de la estimulación subtalámica a largo plazo sobre la situación cognitiva de los pacientes con enfermedad de Parkinson avanzada.

OBJECTIVE: The aim of this study was to evaluate the effects of deep brain stimulation of the subthalamic nucleus (DBS-SN) on cognitive function in patients with Parkinson's disease (PD) 5 years after surgery. MATERIAL AND METHODS: We conducted a prospective study including 50 patients with PD who underwent DBS-SN (62.5% were men; mean age of 62.2±8.2 years; mean progression time of 14.1±6.3 years). All patients were assessed before the procedure and at one year after surgery; 40 patients were further followed up until the 5-year mark. Follow-up assessments included the following neuropsychological tests: Mini-Mental State Examination (MMSE), Mattis Dementia Rating Scale (MDRS), letter-number sequencing of the WAIS-III (WAIS-III-LN), clock-drawing test, Rey auditory verbal learning test (RAVLT), Benton Visual Retention Test (BVRT), Judgment of Line Orientation (JLO) test, FAS Phonemic Verbal Fluency Test, Stroop test, and the Montgomery-Asberg Depression Rating Scale (MADRS). RESULTS: Patients were found to score lower on the MMSE (-0.89%), clock-drawing test (-2.61%), MDRS (-1.72%), and especially phonemic (-13.28%) and sematic verbal fluency tests (-12.40%) at one year after surgery. Delayed recall on the RAVLT worsened one year after the procedure (-10.12%). At 5 years, impairment affected mainly verbal fluency; scores decreased an additional 16.10% and 16.60% in semantic and phonemic verbal fluency, respectively. Moderate decreases were observed in immediate recall (-16.87%), WAIS-III-LN (-16.67%), and JLO test (-11.56%). DISCUSSION: In our sample, DBS-SN did not result in global cognitive impairment 5 years after surgery. Verbal function was found to be significantly impaired one year after the procedure. Impaired learning and visuospatial function may be attributed to degeneration associated with PD.

Predictive factors for early mortality among patients with methicillin-resistant Staphylococcus aureus bacteraemia.

OBJECTIVES: A high proportion of patients with methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia die within a few days of the onset of infection. However, predictive factors for early mortality (EM) have barely been examined. The aim of this study was to determine the predictive factors for EM in patients with MRSA bacteraemia. METHODS: All episodes of MRSA bacteraemia were prospectively followed in 21 Spanish hospitals from June 2008 to December 2009. Epidemiology, clinical data, therapy and outcome were recorded. All MRSA strains were analysed in a central laboratory. Mortality was defined as death from any cause occurring in the 30 days after the onset of MRSA bacteraemia. EM was defined as patients who died within the first 2 days, and late mortality (LM) for patients who died after this period. Multivariate analyses were performed by using logistic regression models. RESULTS: A total of 579 episodes were recorded. Mortality was observed in 179 patients (31%): it was early in 49 (8.5%) patients and late in 130 (22.5%). Independent risk factors for EM were [OR (95% CI)] initial Pitt score >3 [3.99 (1.72-3.24)], previous rapid fatal disease [3.67 (1.32-10.24)], source of infection lower respiratory tract or unknown [3.76 (1.31-10.83) and 2.83 (1.11-7.21)], non-nosocomial acquisition [2.59 (1.16-5.77)] and inappropriate initial antibiotic therapy [3.59 (1.63-7.89)]. When predictive factors for EM and LM were compared, inappropriate initial antibiotic therapy was the only distinctive predictor of EM, while endocarditis and lower respiratory tract sources both predicted LM. CONCLUSIONS: In our large cohort of patients several factors were related to EM, but the only distinctive predictor of EM was inappropriate initial antibiotic therapy.

[Effects of encircling scleral buckling on the morphology and biomechanical properties of the cornea]. / Efecto del cerclaje escleral en la cirugía vítreo-retiniana sobre la morfología y biomecánica de la córnea.

OBJECTIVE: To investigate the effects of encircling scleral buckle (SB) on corneal biomechanical properties of the cornea and its morphological parameters. METHODS: We prospectively examined twelve eyes diagnosed with vitreous haemorrhage undergoing pars plana vitrectomy (PPV), and fifteen eyes undergoing combined PPV and scleral buckle (PPV/SB) for repair of rhegmatogenous retinal detachment (RRD). Corneal biomechanical properties, including corneal hysteresis (CH) and corneal resistance factor (CRF), were measured with an Ocular Response Analyser (ORA) before and 1-month postoperatively. The ORA also determined the values of intraocular pressure (IOPg) and corneal compensated IOP (IOPcc). Finally, four morphological parameters of the cornea were measured with the Orbscan II topographer (Orbtek, Inc.): mean corneal power, thinnest corneal point (µm), and anterior chamber depth (ACD). RESULTS: CH decreased significantly from 10.2+/-1.7mmHg to 7.6+/-1.1mmHg after PPV/SB (p=0.003), but not after PPV alone (9.8+/-3.2mmHg vs 11.6+/-2.7mmHg, P=.465). CRF did not change significantly after surgery in both groups. IOPg and IOPcc increased significantly in the PPV/SB group (P=.019 and P=.010, respectively) but not in PPV group (P=.715 and P=.273, respectively). Unlike the PPV group, values were significantly higher than IOPg values before (P=.001) and after surgery (P=.003) in the PPV/SB group IOPcc. Neither the PPV/SB group nor the PPV group showed any significant changes in the corneal morphological parameters after surgery (P>.05). CONCLUSIONS: SB surgery leads to a change in the corneal biomechanical properties without altering corneal morphological parameters. It may cause an underestimation error in IOP measurement. PPV may be a less invasive surgical approach for the repair of noncomplex RRD than PPV/SB.

Efecto del cerclaje escleral en la cirugia vitreo-retiniana sobre la morfologia y biomecanica de la cornea / Effects of encircling scleral buckling on the morphology and biomechanical properties of the cornea

Objetivo: Valorar los efectos del cerclaje escleral en cirugía vitreo-retiniana, sobre la biomecanica y morfologia del segmento anterior. Metodos: Estudio prospectivo: 15 ojos con desprendimiento de retina (DR), sometidos a vitrectomía pars plana (VPP) implante de cerclaje escleral (grupo 1), y 12 ojos con hemorragia vítrea sometidos a VPP aislada (grupo 2). Se compararon pre y postoperatoriamente las propiedades biomecánicas corneales, mediante Ocular Response Analyzer (ORA): histéresis corneal (CH) y factor de resistencia corneal (CRF), ademas de presión intraocular Goldmann (PIOg) y presión intraocular compensada (PIOcc). Se investigó su relación con 4 parámetros morfológicos obtenidos con Orbscan IIz: potencia media de K (Mean power), desviación estándar (DE), mínimo espesor corneal (Thinnest) y profundidad de cámara anterior (ACD). Resultados: CH descendió de 10,2+/-1,7mmHg a 7,6+/-1,1 en el grupo 1 (p=0,003), pero no en el grupo 2 (9,8+/-3,2 vs 9,6+/-2,7, p=0,465). No hubo cambios en el CRF tras la cirugíaa. PIOg y PIOcc aumentaron significativamente en el grupo 1 (p=0,019 y p=0,010 respectivamente), pero no en el grupo 2 (p=0,715 y p=0,273). No hubo cambios significativos en los parámetros topográficos en ambos grupos (p> 0,05). Test de Wilcoxon. Conclusiones: El cerclaje escleral en la cirugía del DR no modifica significativamente la morfología del segmento anterior, luego la miopización generada se debería exclusivamente a la elongación axial del segmento posterior. La biomecánica corneal sí se altera, disminuyendo la CH. Se aporta un argumento más a favor de la VPP aislada en estas cirugías, que supondría una técnica menos agresiva quirúrgicamente(AU)

Objective: To investigate the effects of encircling scleral buckle (SB) on corneal biomechanical properties of the cornea and its morphological parameters. Methods: We prospectively examined twelve eyes diagnosed with vitreous haemorrhage undergoing pars plana vitrectomy (PPV), and fifteen eyes undergoing combined PPV and scleral buckle (PPV/SB) for repair of rhegmatogenous retinal detachment (RRD). Corneal biomechanical properties, including corneal hysteresis (CH) and corneal resistance factor (CRF), were measured with an Ocular Response Analyser (ORA) before and 1-month postoperatively. The ORA also determined the values of intraocular pressure (IOPg) and corneal compensated IOP (IOPcc). Finally, four morphological parameters of the cornea were measured with the Orbscan II topographer (Orbtek, Inc.): mean corneal power, thinnest corneal point (micro metro), and anterior chamber depth (ACD). Results: CH decreased significantly from 10.2+/-1.7mmHg to 7.6+/-1.1mmHg after PPV/SB (p=0.003), but not after PPV alone (9.8+/-3.2mmHg contra 11.6+/-2.7mmHg, P=.465). CRF did not change significantly after surgery in both groups. IOPg and IOPcc increased significantly in the PPV/SB group (P=.019 and P=.010, respectively) but not in PPV group (P=.715 and P=.273, respectively). Unlike the PPV group, values were significantly higher than IOPg values before (P=.001) and after surgery (P=.003) in the PPV/SB group IOPcc. Neither the PPV/SB group nor the PPV group showed any significant changes in the corneal morphological parameters after surgery (P>.05). Conclusions: SB surgery leads to a change in the corneal biomechanical properties without altering corneal morphological parameters. It may cause an underestimation error in IOP measurement. PPV may be a less invasive surgical approach for the repair of noncomplex RRD than PPV/SB(AU)

[Adult spontaneous cerebrospinal fluid otorrhea. Report of two cases and review of the literature]. / Otolicuorrea espontánea en el adulto. Presentación de dos casos y revisión de la literatura.

INTRODUCTION: Spontaneous cerebrospinal fluid otorrhea is a relatively rare entity and can be easily missed in adults. Every adult older than 50 years with a negative history of otologic disease who has recurrent serous otitis media should be evaluated for this pathology. Meningitis is the most serious complication, so there is no doubt that the condition needs immediate attention and correction. OBJECTIVE: We present two patients who were diagnosed with spontaneous CSF otorrhea and make a review of what is reported about this topic. CONCLUSION: Surgical repair is mandatory to seal these nontraumatic CSF leaks. There are two main surgical approaches, the middle fossa craniotomy and the transmastoid approach. A multilayered closure technique in which autologous and artificial materials are combined is considered to result in the highest rate of success.

Otolicuorrea espontánea en el adulto. Presentación de dos casos y revisión de laliteratura / Adult spontaneous cerebrospinal fluid otorrhea. Report of two cases and review of the literature

Introducción. Las fístulas espontáneas de LCR noson una entidad frecuente y pueden ser infradiagnosticadasen el adulto. Para algunos autores, debesospecharse esta patología en cualquier paciente mayorde 50 años con episodios de otitis serosas recurrentesy ausencia de antecedentes otológicos. La meningitis essu complicación más grave, por lo que es prioritario undiagnóstico precoz y certero.Objetivo. Presentar dos casos clínicos atendidos ennuestro servicio y revisar la literatura científica existenteal respecto.Conclusión El tratamiento de estas fístulas atraumáticases eminentemente quirúrgico, pudiendo emplear lacraneotomía de fosa media o la vía transmastoidea. Enel sellado debe emplearse una técnica multicapa, combinandomateriales autólogos y artificiales para conseguirmejores resultados (AU)

Introduction. Spontaneous cerebrospinal fluid otorrheais a relatively rare entity and can be easily missedin adults. Every adult older than 50 years with a negativehistory of otologic disease who has recurrent serousotitis media should be evaluated for this pathology.Meningitis is the most serious complication, so there isno doubt that the condition needs immediate attentionand correction.Objective. We present two patients who were diagnosedwith spontaneous CSF otorrhea and make areview of what is reported about this topic (..) (AU)

Natural history of meticillin-resistant Staphylococcus aureus colonisation among residents in community long term care facilities in Spain.

The spread of meticillin-resistant Staphylococcus aureus (MRSA) is a major problem for both acute care hospitals and among residents in long term care facilities (LTCFs). We performed a cohort study to assess the natural history of MRSA colonisation in LTCF residents. Two cohorts of residents (231 MRSA carriers and 196 non-carriers) were followed up for an 18 month period, with cultures of nasal and decubitus ulcers performed every six months. In the MRSA carrier cohort, 110 (47.8%) residents had persistent MRSA colonisation for six months or longer, 44 (19.0%) had transient colonisation and nine (3.9%) were intermittently colonised. No risk factors for persistent MRSA colonisation could be determined. The annual incidence of MRSA acquisition was around 20% [95% confidence interval (CI): 14.3-25.5]. Antibiotic treatment was independently associated with MRSA acquisition (odds ratio: 2.27; 95% CI: 1.05-4.88; P=0.03). Just two clones were distinguishable by pulsed-field gel electrophoresis and multilocus sequence typing: CC5-MRSA IV, which is widely disseminated in Spanish hospitals, and ST22-MRSA IV. This study adds to the knowledge of the epidemiology of MRSA in community LTCFs, which are important components of long term care in Spain.

Impact of prior pneumococcal vaccination on clinical outcomes in HIV-infected adult patients hospitalized with invasive pneumococcal disease.

BACKGROUND: Recent studies in hospitalized patients with community-acquired pneumonia have found a lower risk of bacteraemia and better clinical outcomes in patients who had previously received the 23-valent pneumococcal polysaccharide vaccine (PPV) in comparison with unvaccinated individuals. The aim of this study was to assess the influence of prior PPV on clinical outcomes in HIV-infected adult patients hospitalized with invasive pneumococcal disease (IPD). METHODS: This was an observational study of all consecutive HIV-infected adults hospitalized with IPD from January 1996 to October 2007 in three hospitals in Spain. Baseline characteristics and clinical outcome-related variables were compared according to prior PPV vaccination status. RESULTS: A total of 162 episodes of IPD were studied. In 23 of these (14.2%), patients had previously received PPV. In both vaccinated and unvaccinated patients, most of the causal serotypes were included in the 23-valent PPV (76.9% and 84.1%, respectively). Overall, 25 patients (15.4%) died during hospitalization, 21 patients (13%) required admission to an intensive care unit (ICU) and 34 patients (21%) reached the composite outcome of death and/or admission to the ICU. None of the 23 patients who had previously received PPV died or required ICU admission, in comparison with 25 (18%; P=0.026) and 21 (15.1%; P=0.046), respectively, of the unvaccinated patients. The length of hospital stay for vaccinated patients was significantly shorter (8.48 vs. 13.27 days; P=0.011). CONCLUSIONS: Although 23-valent PPV failed to prevent IPD in some HIV-infected patients, vaccination produced beneficial effects on clinical outcomes by decreasing illness severity and mortality related to IPD.

Prevalence of methicillin-resistant Staphylococcus aureus and factors associated with colonization among residents in community long-term-care facilities in Spain.

Hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) strains are no longer limited to acute-care hospitals but have now spread to other healthcare settings such as long-term-care facilities (LTCFs), in most of which they are endemic. In Europe, few studies have addressed the MRSA situation in LTCFs. A cross-sectional study to determine MRSA prevalence and factors associated with S. aureus carriage in community LTCF residents is reported here. Nasal and decubitus ulcer cultures were performed for residents of nine community LTCFs. Residents were classified as MRSA carriers, methicillin-susceptible S. aureus carriers and non-carriers. Overall, 1377 nasal swabs and 82 decubitus ulcer cultures were performed. MRSA was isolated from 15.5% and 59.0% of the former and latter, respectively. The prevalence of MRSA colonization was 16.8% (95% CI 14.9-18.8), varying from 6.7% to 35.8% (p <0.001) among LTCFs. Several independent variables were related to MRSA colonization. It is noteworthy that residents in an LTCF with fewer than 150 beds had at least a two-fold higher probability of being MRSA carriers. Modifiable factors were medical devices, decubitus ulcers and previous antibiotic treatment. An age of 85 years or older, a Charlson index >or=2 and transfer from an acute-care facility were non-modifiable factors also related to MRSA colonization. A high MRSA prevalence among residents in community LTCFs in Spain, with great variability among facilities, was found. The factors identified as being associated with MRSA colonization could be prevented by the implementation of several measures. Control strategies need to be coordinated between LTCFs and acute-care hospitals.

Características clínicas y epidemiológicas de los pacientes pediátricos con neumonía causada por los virus gripales / Clinical and epidemiological characteristics of the pediatric patients with influenza virus-induced pneumonia

Estudio retrospectivo sobre características clínicas y epidemiológicas de los pacientes pediátricos con neumonía y aislamiento de virus gripales (influenza A y B) durante el período 1995-2005. A las muestras respiratorias se les realizó la detección antigénica frente a los virus gripales y el aislamiento viral en cultivo celular. Durante el período de estudio se han diagnosticado 598 casos de infección respiratoria aguda causada por los virus gripales A y B, de los cuales 414 (69,2%) correspondían a pacientes pediátricos. Se diagnosticó neumonía gripal en 28 casos (6,7%). El virus gripal tipo A fue aislado en 22 casos (78,5%) y el virus gripal tipo B en 6 casos (21,5%). Los 22 virus gripales A fueron subtipados como pertenecientes 17 al subtipo H3 (77,2%) y 5 al subtipo H1 (22,8%). Las principales manifestaciones clínicas fueron: fiebre (96,4%), tos (78,5%), rinorrea (28,5%), cefalea (28,5%), otitis media aguada (14,2%) y mialgias, diarrea y conjuntivitis (3,5%). La edad media de nuestros pacientes fue de 4,4 años. El 75% de los pacientes precisó del ingreso hospitalario debido a su corta edad o complicaciones patológicas. En los pacientes ingresados se observó una estancia media de 8,3 días (intervalo de 3-17 días). Las manifestaciones clínicas son muy similares a las observadas en el resto de infecciones respiratorias agudas, precisando el estudio virológico para establecer su etiología definitiva (AU)

We performed a retrospective study of the clinical and epidemiological characteristics of pediatric patients with pneumonia and isolation of influenza viruses A and B during the 1995-2005 period. The specific antigenic detection and viral isolation in cell culture were the methods used in the etiological diagnosis. In the study period we detected 598 cases of acute respiratory infection caused by influenza ciruses A and B; of them 414 (69.2%) in pediatric patients. We could diagnosticated 28 patients (6.7%) with influenza pneumonia. Influenza A virus was isolated in 22 (78.5%) patients and Influenza B virus in 6 (21.5%) patients. The 22 influenza A viruses were subtyped as 17 (77,2%) H3 and 5 (22,8%) H1 subtypes. The most frequent clinical manifestations detected in the patients with pneumonia were: fever (96.4%), cough (78.5%), rhinorrea (28.5%), headache (28.5%), acute otitis (14,2%) and mialgia, diarrhea and conjunctivitis (3.5%). The mean age of patients was 4.4 years old; 75% of patients were hospitalized with a media of 8.3 days (3-17 days). The clinical manifestations of this pathology were very similar to detected in other acute viral respiratory infections, so only the virological methods could established the definitive etiological diagnosis (AU)

Molecular epidemiology of methicillin-resistant Staphylococcus aureus in Majorcan hospitals: high prevalence of the epidemic clone EMRSA-15.

Clinical isolates (n = 389) of methicillin-resistant Staphylococcus aureus (MRSA) recovered from 371 patients between January 2003 and June 2004 at the three major public hospitals on the island of Majorca, Spain were studied. The clonal relatedness of MRSA isolates was determined by pulsed-field gel electrophoresis (PFGE) after digestion with SmaI. During the study period, MRSA was found in 31% of patients with S. aureus-positive cultures. PFGE analysis identified three predominant clones, affecting 94% of the patients. The three clones had been detected since 1999 in one hospital, and were designated as clones A, B and C. Whereas clones A and B (multidrug-resistant) were related to the two most prevalent clones in Spain at this time, clone C was identical to EMRSA-15, currently one of the most common MRSA clones in UK hospitals and also detected in other countries, but rarely in Spanish hospitals. This imported epidemic clone was detected in c. 10% of patients admitted to one of the three hospitals in 2002, but its prevalence has increased significantly (32% of the patients investigated in the three hospitals in the present study), and this clone also accounted for 44% of the isolates from non-hospitalised patients. Even though EMRSA-15 showed the least multidrug resistance of the three major clones, it was apparently more virulent, since it was associated significantly (p 0.001) with bacteraemia, and positive blood cultures were documented for 21% of the patients infected by this clone, compared with only 10% and 7% of patients infected with clones A and B, respectively.

Evolución de los grupos de edad y edad media de los pacientes pediátricos infectados por los virus gripales A y B durante el periodo 1995-2005 / Evolution of the age groups and mean age of the pediatric patients infected by influenza virus A and B during the period 1995-2005

Se ha realizado un estudio prospectivo sobre la evolución de los diferentes grupos de edad y edad media de los pacientes pediátricos (0,05). El subtipado de los virus influenza A ha demostrado que 271 (86,8%) pertenecían al subtipo H3 y 41 (13,2%) al subtipo H1 (p<0,05). La edad media de los pacientes estudiados ha sido de 20,7 meses (intervalo 11 días y 15 años). El 73,8% de los pacientes presentaron una edad situada entre 0-2 años (p<0,05), 14,1% entre 2-5 años, 6,1% entre 6-10 años y 6% entre 11-15 años. El porcentaje medio de pacientes entre 0-5 meses ha sido el 24,8% (intervalo 11,1%-47,3%)y de entre 6-23 meses del 29,9% (intervalo 13,6-58,6%). La circulación del virus influenza B/Hong Kong/330/01 en la temporada 2003-2004 determinó unincremento significativo de la edad media de los pacientes (55,2 meses). La posible aplicación de las nuevas recomendaciones para la vacuna antigripal (mujeres embarazadas en el segundo-tercer trimestre y niños sanos entre 6-23 meses) podría determinar una disminución teórica del 65,2% de todos los casos de infección gripal

We report a prospective study about the evolution of different age groups and median age in pediatric patients (under 15 years) with influenza infection detected in ten consecutive flu epidemics (1995-2005). All respiratory samples were submitted to antigen detection and influenza A and B viral isolation (MDCK cell culture). In this period we studied 10.937 respiratory samples; 4.6% were positive for influenzaciruses (3.5% influenza A and 1.1% influenza B). We studied 414 patients, 234 (56,5%) boys and 180 (43.5%) girls. We detected 312 (75.4%) patients with influenza A and 102 (24.6%) with influenza B (p>0.05). The influenza A subtypes detected were 271 (86.8%) H3 and 41 (13.2%) H1 (p<0.05). The median age of patients was 20.7 months (range 11 days to 15 years (pz0.05)), 14,1% between 2-5 years, 6,1% between 6-10 years and 6% between 11-15 years. the median percentage of patients between 0-5 months was 24.8% (range 11.1%-58.6%). The circulation of influenza B/Hong Kong/330/01 virus in the period 2003-2004 was the main cause of increase in the median age of patients (55.2 months). The application of new anti-flu vaccination recommendations (pregnant women second-third trimester and healthy young children between 6-23 months) could theoretically decrease the 65.2% of all pediatric patients with influenza virus infections

Prospective evaluation of a dot-blot enzyme immunoassay (Directigen RSV) for the antigenic detection of respiratory syncytial virus from nasopharyngeal aspirates of paediatric patients.

This study investigated the efficacy of a commercial enzyme immunoassay (Directigen RSV, ColorPAC) in comparison with the shell vial culture method (using Hep-2 cells) for the detection of respiratory syncytial virus (RSV) in nasopharyngeal aspirates from children with bronchiolitis. During the period 1995-2002, 4950 samples were examined. RSV was detected in 1660 (33.5%) samples, with a sensitivity of 80.9%, a specificity of 97.5%, a positive predictive value of 93.8%, a negative predictive value of 91.6%, and a testing efficiency value of 92.2% compared with shell vial culture. In 83 (5%) samples, the ColorPAC was positive and the shell vial assay was negative. Of these, 71 (85.6%) were false-negative by cell culture. The true false-positive results obtained by ColorPAC represented only 0.7% of all RSV-positive samples. In general, no statistically significant differences were detected between the different months and epidemic periods studied. Compared with ColorPAC, the shell vial culture method displayed a sensitivity of 95.8% and a specificity of 100%. Overall, the ColorPAC assay was an acceptable, simple and rapid method for the antigenic detection of RSV in paediatric respiratory samples.

Características clínicas y epidemiológicas de los pacientes infectados por el virus influenza B/Hong Kong/330/2001 en las Islas Baleares (2002-2003) / clinical and epidemiological characteristics of patients infected by influenza B/Hong Kong/330/2001 virus in Balearic Islands (2002-2003)

Se revisan las características clínicas y epidemiológicas de los niños infectados por el virus influenza B/Hong Kong/330/01 (IB) en la temporada epidémica 2002-2003 y se compara con los diagnosticados en dos temporadas previas. Todas las muestras fueron sometidas a la detección antigénica y al cultivo viral (línea celular MDCK). Sólo se pudo realizar el seguimiento en 40 (87 por ciento) niños infectados por el virus IB. De los casos estudiados, 24 (60 por ciento) eran niños y 16 (40 por ciento) niñas. La edad media fue de 4,6 años (rango 27 días-15 años). Quince niños (37,5 por ciento) fueron considerados inmunodeprimidos. Se detectó fiebre en el 92,5 por ciento, síntomas respiratorios en el 85 por ciento, manifestaciones neurológicas en el 15 por ciento, exantemas en el 12,5 por ciento y síntomas musculares en el 12,5 por ciento. Los diagnósticos clínicos defintivos fueron: infección del tracto respiratorio superior 40 por ciento, neumonía 20 por ciento, fiebre y exantema 7,5 por ciento, otitis aguda media 7,5 por ciento, miositis 5 por ciento, bronquiolitis 2,5 por ciento y poliartralgias 2,5 por ciento. Se observó un posible caso, no confirmado, de encefalopatía asociado a infección por el virus IB. Un paciente oncológico (2,5 por ciento) falleció de una neumonía asociada al virus IB. Ninguno de los pacientes había sido vacunado frente a los virus gripales. De acuerdo con los datos obtenidos los niños infectados por el virus influenza B/Hong Kong/330/01 poseerían una edad media de 4,6 años y presentarían un síndrome febril con patología respiratoria y/o manifestaciones clínicas atípicas que requieren ingreso hospitalario (AU)

Estudio de las características clínicas y epidemiológicas de las infecciones respiratorias por adenovirus en una población infantil (1997-2003) / Study of the clinical and epidemiological characteristics of respiratory infections caused by adenovirus in a pediatric population (1997-2003)

Introducción Las infecciones por adenovirus son muy prevalentes en la edad infantil. Las infecciones respiratorias presentan unas manifestaciones clínicas inespecíficas que obligan al empleo de métodos virológicos para el establecimiento de su etiología. Se presenta un estudio retrospectivo sobre las características clínicas y virológicas de los pacientes con aislamiento de adenovirus en muestras respiratorias. Material y métodos: Durante el período 1997-2003 se estudiaron 5.746 muestras respiratorias pediátricas (< 15 años) de las cuales 2.122 (36,9 por ciento) fueron consideradas positivas. Los adenovirus se aislaron en cultivo celular utilizando la línea Hep-2 y cultivo tipo shell vial. Resultados: En 100 muestras se pudo aislar adenovirus (4,7 por ciento de las muestras positivas y 1,7 por ciento de todas las muestras) presentando los pacientes una edad media de 14 meses. El diagnóstico clínico de los pacientes fue de bronquiolitis (61 por ciento), neumonía (10 por ciento), tos pertussoide (16 por ciento) y crisis asmática (11 por ciento). Las infecciones por adenovirus se han presentado preferentemente entre los meses de diciembre y marzo. El 72 por ciento de los pacientes presentaban antecedentes previos de otras infecciones virales respiratorias o manifestaciones clínicas de asma bronquial. Ningún paciente presentó conjuntivitis y sólo en cinco se detectó diarrea causada por adenovirus. El 70 por ciento de los pacientes habían recibido lactancia artificial y el 30 por ciento, lactancia materna. El 90 por ciento de los pacientes precisaron ingreso hospitalario, y fueron tratados preferentemente con broncodilatadores y antibióticos. Conclusiones: Las infecciones respiratorias por adenovirus se presentan preferentemente en pacientes menores de 14 meses, durante el primer cuatrimestre del año, y presentan manifestaciones de bronquiolitis o neumonía sin conjuntivitis, difícilmente diferenciables de las ocasionadas por otros virus respiratorios. (AU)

[Study of the clinical and epidemiological characteristics of respiratory infections caused by adenovirus in a pediatric population (1997-2003)]. / Estudio de las características clínicas y epidemiológicas de las infecciones respiratorias por adenovirus en una población infantil (1997-2003).

INTRODUCTION: Infections due to adenoviruses are highly prevalent in pediatric patients. Because the clinical manifestations of the respiratory infections caused by adenoviruses are indistinguishable from those caused by other respiratory viruses, virological methods are required to establish their etiology. We present a retrospective study of the clinical and virological characteristics of patients with isolation of adenovirus in respiratory samples. MATERIAL AND METHODS: From 1997 to 2003 we analyzed 5,746 respiratory samples from pediatric patients (< 15 years old), of which 2,122 (36.9 %) were considered positive. The adenoviruses were isolated in the Hep-2 cell line culture by the shell vial method. RESULTS: Adenovirus was isolated in 100 clinical samples (4.7 % of all positive samples and 1.7 % of all samples studied) in a group of pediatric patients with a mean age of 14 months. The clinical diagnoses of patients were bronchiolitis (61 %), pneumonia (10 %), pertussis-like syndrome (16 %) and asthmatic crisis (11 %). Adenovirus infections mainly presented between December and March. Seventy-two percent of patients had a history of other viral respiratory tract infections and/or bronchial asthma. None of the patients had clinical conjunctivitis and only five patients had diarrhea due to adenoviruses. Seventy percent of the patients received artificial feeding and 30 % were breast-fed. Ninety percent of the patients were hospitalized and treatment mainly consisted of bronchodilator agents and antibiotics. CONCLUSIONS: Respiratory tract infections caused by adenoviruses mainly affected patients aged less than 14 months, in the first four months of the year, and with clinical manifestations of bronchiolitis or pneumonia without conjunctivitis. Clinically, these infections are difficult to differentiate from other viral respiratory infections.

Epidemiological relatedness of methicillin-resistant Staphylococcus aureus from a tertiary hospital and a geriatric institution in Spain.

From January 2000 to June 2002, 24 Staphylococcus aureus isolates were recovered from decubitus ulcers of patients in a geriatric institution, of which 17 (70.8%) were methicillin-resistant S. aureus (MRSA). Antibiotic resistance and DNA macrorestriction (pulsed-field gel electrophoresis; PFGE) patterns of the MRSA isolates were compared with a collection of 161 MRSA isolates from patients admitted to the institution's reference hospital. PFGE revealed the presence of five clonal types (found also in hospitalised patients) among the 17 MRSA isolates. The findings suggest nosocomial acquisition of the MRSA strains by five patients, with subsequent dissemination of the strains within the institution. The high rate of MRSA highlights the need for epidemiological analysis to control the dissemination of MRSA in long-term care facilities.

Aislamiento de poliovirus vacunales en diferentes muestras clínicas (1997-2002) / Isolation of vaccine polioviruses in different clinical samples (1997-2002)

Se presenta un estudio retrospectivo sobre las características clínicas y epidemiológicas de un grupo de niños con aislamiento de poliovirus vacunales en muestras clínicas. Durante el período 1997-2002 se han estudiado 29 casos (20 niños y 9 niñas) con aislamiento de poliovirus vacunales en muestras clínicas (frotis faríngeo y/o heces). Se han observado dos grupos diferentes, uno con el aislamiento simultáneo de un virus respiratorio (VRS y/o adenovirus) y otro con aislamiento exclusivo de los poliovirus. Desde el punto de vista clínico, la presencia de los poliovirus en el primer grupo (41,4 por ciento) es un dato casual (vacunación oral reciente) y sin valor clínico en el proceso respiratorio. El segundo grupo (58,6 por ciento) corresponde a niños recién vacunados frente a la poliomielitis con manifestaciones secundarias al proceso vacunal (fiebre y manifestaciones gastrointestinales). Todos los niños han presentado buena evolución a pesar de que el 38 por ciento precisó de ingreso hospitalario. La próxima sustitución de la vacuna oral (atenuada) frente a la poliomielitis por la vacuna parenteral (inactivada) evitará la aparición de estos efectos clínicos secundarios y la excreción continuada del propio virus al medio ambiente (AU)

Establecimiento de la probabilidad etiológica en las bronquiolitis víricas de la población lactante / Establishment of the etiologic probability in viral bronchiolitis presented in infant population

Se presenta un estudio prospectivo (enero 1995-diciembre 2001) destinado al establecimiento de la probabilidad etiológica en las bronquiolitis víricas que afectan a la población lactante < 2 años). Durante este período de tiempo se han analizado 6.072 muestras, de las cuales 2.152 (35,4 por ciento) fueron positivas. El virus respiratorio sincitial (VRS) ha sido el más aislado en este estudio (76,6 por ciento), seguido de los virus gripales (10,9 por ciento), virus de la parainfluenza (7,3 por ciento) y adenovirus (5,1 por ciento). El estudio epidemiológico ha demostrado el predominio del VRS y virus gripales en los meses invernales (diciembre-marzo), lo cual ha determinado que estos virus sean los responsables del porcentaje más elevado de bronquiolitis en este período (probabilidad etiológica). Destaca el adelantamiento de las epidemias causadas por el VRS al mes de diciembre a partir del período 1998-1999. Los virus gripales se presentan preferentemente entre enero y marzo y las bronquiolitis que producen son clínicamente indistinguibles de las causadas por el VRS. Se ha observado un incremento significativo del número de casos de bronquiolitis causadas por el virus gripal tipo A (influenza A) en los últimos años. El virus de la parainfluenza ha predominado en los meses de primavera y verano, siendo el virus que muestra la máxima probabilidad etiológica desde mayo hasta septiembre. La mayoría (88 por ciento) de las infecciones por el virus parainfluenza lo han sido por el serotipo 3. Los adenovirus se han presentado a lo largo del año con un cierto predominio en los meses invernales. Se ha detectado un incremento significativo en el aislamiento de estos virus en los últimos años. El conocimiento de la distribución y presentación epidemiológica de los virus respiratorios permite establecer la probabilidad etiológica de las bronquiolitis víricas en los lactantes en cada mes del año y elaborar los protocolos de diagnóstico y actuación hospitalaria más adecuados frente a cada uno de ellos. (AU)