Publicaciones científicas de los pediatras españoles de Atención Primaria en los últimos seis años (2015-2020) / Scientific publications of primary care paediatricians in Spain the last six years (2015-2020)

Introducción: la actividad asistencial debería ir siempre ligada a una investigación de calidad, ya que mediante el método científico se analizan y estudian los problemas para buscar sus causas o soluciones, formando parte de un proceso de mejora continua de la asistencia clínica. El objetivo del presente estudio es conocer la frecuencia de participación de los pediatras de Atención Primaria (PAP) como autores de publicaciones de las principales revistas pediátricas nacionales e internacionales. Material y métodos: estudio descriptivo transversal. Se realizó una revisión de las autorías de los artículos publicados en todas las revistas pediátricas nacionales y regionales y en las tres revistas internacionales pediátricas de mayor relevancia, en el periodo de tiempo comprendido desde el 1 de enero de 2015 al 30 de junio de 2020. Resultados: se revisaron 6398 artículos, 2030 artículos de revistas nacionales y 4368 artículos de revistas internacionales. En los artículos de revistas nacionales, había un PAP entre los autores en 410 (20,2%), participaban exclusivamente PAP en 117 (5,8%) y el primer firmante era un PAP en 258 (12,7%). En los artículos de revistas internacionales, 31 (0,71%) contienen entre sus firmantes algún autor español y solo 5 cuentan con la participación de al menos un PAP. Conclusiones: la actividad investigadora y de publicaciones de ámbito nacional de los PAP es baja. A nivel internacional, hay pocas publicaciones de los pediatras españoles en las principales revistas pediátricas, siendo muy minoritaria la presencia de publicaciones de PAP en estas revistas (AU)

Introduction: health care delivery should always be associated with quality research, as the scientific method is used to assess and investigate problems to identify their causes or solutions as part of an ongoing health care quality improvement process. The objective of our study was to determine the frequency with which primary care paediatricians (PCPs) in Spain contribute as authors of publications in the main national and international paediatric journals.Material and methods: descriptive cross-sectional study. We reviewed the authorship of the articles published in every Spanish national and regional paediatric journal and in the 3 most relevant international paediatric journals in the period ranging from January 1, 2015 to June 30, 2020.Results: the review included a total of 6398 articles, 2030 from national journals and 4368 articles from international journals. In the group of articles published in Spanish journals, we found authors that were PCPs in 410 (20.2%), with exclusive participation of PCPs in 117 (5.8%) and a PCP listed as the first author in 258 (12.7%). In articles published in international journals, 31 (0.71%) had a Spanish author in the list, and only 5 listed at least one Spanish PCP.Conclusions: involvement in research and contribution to national scientific journals is low among PCPs. At the international level, there are few publications by Spanish paediatricians in the main paediatric journals, with an extremely low number of contributions by PCPs in these journals. (AU)

Epinephrine Improves the Efficacy of Nebulized Hypertonic Saline in Moderate Bronchiolitis: A Randomised Clinical Trial.

BACKGROUND AND AIMS: There is no evidence that the epinephrine-3% hypertonic saline combination is more effective than 3% hypertonic saline alone for treating infants hospitalized with acute bronchiolitis. We evaluated the efficacy of nebulized epinephrine in 3% hypertonic saline. PATIENTS AND METHODS: We performed a randomized, double-blind, placebo-controlled clinical trial in 208 infants hospitalized with acute moderate bronchiolitis. Infants were randomly assigned to receive nebulized 3% hypertonic saline with either 3 mL of epinephrine or 3 mL of placebo, administered every four hours. The primary outcome measure was the length of hospital stay. RESULTS: A total of 185 infants were analyzed: 94 in the epinephrine plus 3% hypertonic saline group and 91 in the placebo plus 3% hypertonic saline group. Baseline demographic and clinical characteristics were similar in both groups. Length of hospital stay was significantly reduced in the epinephrine group as compared with the placebo group (3.94 ±1.88 days vs. 4.82 ±2.30 days, P = 0.011). Disease severity also decreased significantly earlier in the epinephrine group (P = 0.029 and P = 0.036 on days 3 and 5, respectively). CONCLUSIONS: In our setting, nebulized epinephrine in 3% hypertonic saline significantly shortens hospital stay in hospitalized infants with acute moderate bronchiolitis compared to 3% hypertonic saline alone, and improves the clinical scores of severity from the third day of treatment, but not before. TRIAL REGISTRATION: EudraCT 2009-016042-57.

[Effectiveness and efficacy of self-measurement of capillary blood glucose in patients with type 2 diabetes mellitus]. / Efectividad y eficacia del autoanálisis de la glucemia capilar en pacientes con diabetes tipo 2.

BACKGROUND AND OBJECTIVE: The efficacy of self-measurement of capillary blood glucose (SMBG) in patients with type 2 diabetes mellitus is not fully established. The objectives of the study were: a) to verify the efficacy of the SMBG in patients with type 2 diabetes mellitus in the primary care set; b) to investigate the possible causes that explain the lack of effectiveness of the method, in their case, and c) to deduce the predictive variables that permit to select good utilizador of the SMBG. PATIENTS AND METHOD: Clinical trial controlled and randomized carried out in the environment of the primary care, on type 2 diabetic patients. The patients were assigned, of random form and stratified, according to the type of treatment for diabetes that received, in 2 groups: SMBG group (SMBG-G) and control group (CG). The period of monitoring was of 12 months. The efficacy of the SMBG was analyzed, and also its effectiveness. RESULTS: 100 patients were included in the study. Out of them, 51 were assigned to SMBG-G and 49 to CG. The SMBG was efficient in the 21.6% of SMBG-G and in 14.3% patients of the CG (p = 0.44). The SMBG efficacy was greater in patients with combined treatment and in those who received only insulin (50% in both cases). No improvement was observed in patients on treatment with diet (p = 0.006). The effectiveness for the cut off from value the HbA1c was of 59.2% and of 29.58% for the totality of the European criteria of metabolic control. The independent predictor variables of the SMBG efficacy were: the evolution years number of the diabetes mellitus and a deficient control of the illness at the start of the study. The global precision of the mathematical model obtained was of 88.24% with sensibility of 54.5%, especificity of 97.5%, positive predictor value of 85.7% and negative predictive value of 11.4% (p < 0.001). The area under the ROC curve was of 89.9% (p < 0.001) (95% confidence interval, 81.2-98.5%). According to the ROC curve, the point of cut that better the SMBG efficacy discriminated was that of 74% (sensibility: 72.7%; especificity: 77.5%). CONCLUSIONS: SMBG is a tool that, although can improve the metabolic control of type 2 diabetes, requires a careful selection of patients and, therefore, cannot be utilized in an indiscriminate way. The time of evolution of the illness and fundamentally, the presence of a deficient metabolic control of the disease should be the factors that determine a good selection. Therefore, its extended use among the type 2 diabetic population, without a prior selection, does not seem to be justified.

Efectividad y eficacia del autoanálisis de la glucemia capilar en pacientes con diabetes tipo 2 / Effectiveness and efficacy of self-measurement of capillary blood glucose in patients with type 2 diabetes mellitus

Fundamento y objetivo: La eficacia del autoanálisis (AA) de la glucemia capilar en los pacientes con diabetes tipo 2 no está plenamente establecida. Los objetivos del presente estudio han sido: a) comprobar la eficacia del AA en pacientes con diabetes mellitus tipo 2 en el ámbito de la atención primaria; b) indagar las posibles causas que expliquen la falta de efectividad del método, en su caso, y c) deducir los factores predictivos que permitan seleccionar al buen utilizador del AA. Pacientes y método: Se trata de un ensayo clínico controlado y aleatorizado realizado en el ámbito de la atención primaria, en pacientes con diabetes mellitus tipo 2. Éstos se asignaron, de forma aleatoria y estratificada, según el tipo de tratamiento antidiabético que recibían, en 2 grupos: grupo de autoanálisis (GAA) y grupo control (GC). El período de seguimiento fue de 12 meses. Se analizaron la eficacia del AA y su efectividad. Resultados: De los 100 pacientes incluidos en el estudio, 51 fueron asignados al GAA y 49 al GC. El AA fue eficaz en el 21,6% de los pacientes del GAA frente al 14,3% en el GC (p = 0,44). La eficacia del AA fue mayor en los grupos de pacientes con tratamiento combinado y con tratamiento exclusivamente insulínico (un 50% en ambos casos), sin observarse mejoría en el grupo de tratamiento exclusivo con dieta (p = 0,006). La efectividad para el valor aislado de la hemoglobina glucosilada fue del 59,2%, y del 29,58% para la totalidad de los criterios europeos de control metabólico. Las variables predictoras independientes de la eficacia del AA fueron el número de años de evolución de la diabetes mellitus y un control deficiente de la enfermedad al inicio del estudio. La precisión global del modelo matemático obtenido fue del 88,24%, con una sensibilidad del 54,5%, especificidad del 97,5%, valor predictivo positivo del 85,7% y valor predictivo negativo del 11,4% (p < 0,001). El área bajo la curva de eficacia diagnóstica fue del 89,9% (p < 0,001) (intervalo de confianza del 95%, 81,2-98,5%). El punto de corte que, según la curva de eficacia diagnóstica, mejor discriminó la eficacia del AA fue el 74% (sensibilidad del 72,7% y especificidad del 77,5%). Conclusiones: El AA de la glucemia capilar es una herramienta que, aunque puede mejorar el control metabólico de la diabetes tipo 2, requiere una cuidadosa selección de pacientes y, por tanto, no puede utilizarse de manera indiscriminada. El tiempo de evolución de la enfermedad y, fundamentalmente, la presencia de un deficiente control metabólico de ésta deben ser los factores que determinen dicha selección. Por consiguiente, su extendido uso entre la población con diabetes tipo 2 sin una selección previa no parece estar justificada

Background and objective: The efficacy of self-measurement of capillary blood glucose (SMBG) in patients with type 2 diabetes mellitus is not fully established. The objectives of the study were: a) to verify the efficacy of the SMBG in patients with type 2 diabetes mellitus in the primary care set; b) to investigate the possible causes that explain the lack of effectiveness of the method, in their case, and c) to deduce the predictive variables that permit to select good utilizador of the SMBG. Patients and method: Clinical trial controlled and randomized carried out in the environment of the primary care, on type 2 diabetic patients. The patients were assigned, of random form and stratified, according to the type of treatment for diabetes that received, in 2 groups: SMBG group (SMBG-G) and control group (CG). The period of monitoring was of 12 months. The efficacy of the SMBG was analyzed, and also its effectiveness. Results: 100 patients were included in the study. Out of them, 51 were assigned to SMBG-G and 49 to CG. The SMBG was efficient in the 21.6% of SMBG-G and in 14.3% patients of the CG (p = 0.44). The SMBG efficacy was greater in patients with combined treatment and in those who received only insulin (50% in both cases). No improvement was observed in patients on treatment with diet (p = 0.006). The effectiveness for the cut off from value the HbA1c was of 59.2% and of 29.58% for the totality of the European criteria of metabolic control. The independent predictor variables of the SMBG efficacy were: the evolution years number of the diabetes mellitus and a deficient control of the illness at the start of the study. The global precision of the mathematical model obtained was of 88.24% with sensibility of 54.5%, especificity of 97.5%, positive predictor value of 85.7% and negative predictive value of 11.4% (p < 0.001). The area under the ROC curve was of 89.9% (p < 0.001) (95% confidence interval, 81.2-98.5%). According to the ROC curve, the point of cut that better the SMBG efficacy discriminated was that of 74% (sensibility: 72.7%; especificity: 77.5%). Conclusions: SMBG is a tool that, although can improve the metabolic control of type 2 diabetes, requires a careful selection of patients and, therefore, cannot be utilized in an indiscriminate way. The time of evolution of the illness and fundamentally, the presence of a deficient metabolic control of the disease should be the factors that determine a good selection. Therefore, its extended use among the type 2 diabetic population, without a prior selection, does not seem to be justified

PST1 and ECM33 encode two yeast cell surface GPI proteins important for cell wall integrity.

Pst1p was previously identified as a protein secreted by yeast regenerating protoplasts, which suggests a role in cell wall construction. ECM33 encodes a protein homologous to Pst1p, and both of them display typical features of GPI-anchored proteins and a characteristic receptor L-domain. Pst1p and Ecm33p are both localized to the cell surface, Pst1p being at the cell membrane and possibly also in the periplasmic space. Here, the characterization of pst1Delta, ecm33Delta and pst1Delta ecm33Delta mutants is described. Deletion of ECM33 leads to a weakened cell wall, and this defect is further aggravated by simultaneous deletion of PST1. As a result, the ecm33Delta mutant displays increased levels of activated Slt2p, the MAP kinase of the cell integrity pathway, and relies on a functional Slt2-mediated cell integrity pathway to ensure viability. Analyses of model glycosylated proteins show glycosylation defects in the ecm33Delta mutant. Ecm33p is also important for proper cell wall ultrastructure organization and, furthermore, for the correct assembly of the mannoprotein outer layer of the cell wall. Pst1p seems to act in the compensatory mechanism activated upon cell wall damage and, in these conditions, may partially substitute for Ecm33p.

[Clinical prediction of endoscopic signs in active or recent upper gastrointestinal bleeding]. / Predicción clínica de los signos endoscópicos de hemorragia digestiva alta activa o reciente.

BACKGROUND AND OBJECTIVE: The aim of this study was to construct and validate a mathematical model, based on clinical and laboratory data, that could be useful in the emergency department (ED) to predict which patients with upper gastrointestinal bleeding (UGB) have an active or recent bleeding. PATIENTS AND METHOD: During a period of 12 months, we included all consecutive cases of UGB that came to the ED of an urban hospital. These patients made up the primary or model obtaining series. During the 12 following months, we selected a sample of UGB patients who made up the secondary series. The mathematical predictive model was built using logistic regression analysis. RESULTS: 623 patients made up the primary series and 251 the secondary series. A score equal or higher than 4 indicated the best diagnosis accuracy (63.6%) with positive and negative predictive values of 65.1 and 40.0%, respectively. The discriminative power of the model was significant (p < 0.001) but it displayed little accuracy. CONCLUSIONS: Shock, positive tilt test, increased uremia, previous hematemesis, to be an usual alcohol drinker, presence of sweating, and no previous treatment with antiulcer drugs were independent predictors for active or recent bleeding. The diagnostic accuracy of the model does not not allow its systematic use in clinical practice. However, it may be helpful for the triage of upper gastrointestinal bleeding in the ED.

Predicción clínica de los signos endoscópicos de hemorragia digestiva alta activa o reciente / Clinical prediction of endoscopic signs in active or recent upper gastrointestinal bleeding

FUNDAMENTO Y OBJETIVO: Estudio diseñado para elaborar un modelo matemático, basado en datos clínicos y analíticos, que permita predecir qué pacientes con hemorragia digestiva alta (HDA) tienen signos endoscópicos de hemorragia activa o reciente (SEHA-R).PACIENTES Y MÉTODO: Se incluyeron todos los casos de HDA que acudieron a un servicio de urgencias hospitalario durante 12 meses. Estos pacientes constituyeron la serie primaria del modelo. Durante los 12 meses siguientes se seleccionó una muestra de pacientes con HDA que integraron la serie de validación. El modelo matemático fue construido mediante regresión logística. RESULTADOS: La serie primaria fue de 623 pacientes y la serie de validación, de 251. La presencia de shock, un test de la inclinación positivo, la elevación de la uremia, la referencia de hematemesis, ser bebedor habitual de alcohol, la presencia de sudación y la ausencia de tratamiento previo con fármacos antiulcerosos fueron predictores independientes de los SEHA-R. Una puntuación mayor o igual a 4 fue la que mejor precisión diagnóstica obtuvo (63,6 por ciento), con unos valores predictivos positivo y negativo del 65,1 y el 40,0 por ciento, respectivamente. El poder discriminante del modelo fue significativo (p < 0,001) pero de baja exactitud. CONCLUSIONES: La precisión diagnóstica del modelo predictivo no permite su recomendación sistemática en la práctica clínica, si bien puede ser útil como un instrumento orientativo en la selección de pacientes con HDA en la consulta de urgencias (AU)