Impacto de una estrategia continuada de mejora de la calidad en la atención de los pacientes con bronquiolitis aguda en un servicio de urgencias pediátrico

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Pediatría. Fecha de lectura: 30-05-201

Social Network Analysis and Resilience in University Students: An Approach from Cohesiveness

13 p.The Social Network Analysis offers a view of social phenomena based on interactions. The aim of this study is to compare social reality through the cohesion variable and analyse its relationship with the resilience of university students. This information is useful to work with the students academically and to optimise the properties of the network that have an influence in academic performance. This is a descriptive transversal study with 90 students from the first and third year of the Nursing Degree. Cohesion variables from the support and friendship networks and the level of resilience were gathered. The UCINET programme was used for network analysis and the SPSS programme for statistical analysis. The students’ friendship and support networks show high intra-classroom cohesion although there are no differences between the support networks and friendship or minimal contact networks in both of the courses used for the study. The network cohesion indicators show less cohesion in the third year. No correlations were found between cohesion and resilience. Resilience does not appear to be an attribute related to cohesion or vice versa.S

Acral peeling as the sole skin manifestation of COVID-19 in children.

Skin lesions in children with proven COVID-19 are not frequent in the literature apart from those associated with multisystem inflammatory syndrome. Fortunately, microbiologic testing for SARS-CoV-2 has become widely available not only for admitted patients but also for mild cases. We present a series of 6 children with mild erythema and desquamation of the fingertips and/or toes as the only skin manifestation of COVID-19. As all children had asymptomatic to mildly symptomatic disease, it is reasonable to consider this a sign of benign disease and favorable outcome

Type I Interferon Drives Dendritic Cell Apoptosis via Multiple BH3-Only Proteins following Activation by PolyIC In Vivo

BACKGROUND: DC are activated by pathogen-associated molecular patterns (PAMPs), and this is pivotal for the induction of adaptive immune responses. Thereafter, the clearance of activated DC is crucial to prevent immune pathology. While PAMPs are of major interest for vaccine science due to their adjuvant potential, it is unclear whether and how PAMPs may affect DC viability. We aimed to elucidate the possible apoptotic mechanisms that control activated DC lifespan in response to PAMPs, particularly in vivo. METHODOLOGY/PRINCIPAL FINDINGS: We report that polyinosinic:polycytidylic acid (PolyIC, synthetic analogue of dsRNA) induces dramatic apoptosis of mouse splenic conventional DC (cDC) in vivo, predominantly affecting the CD8α subset, as shown by flow cytometry-based analysis of splenic DC subsets. Importantly, while Bim deficiency conferred only minor protection, cDC depletion was prevented in mice lacking Bim plus one of three other BH3-only proteins, either Puma, Noxa or Bid. Furthermore, we show that Type I Interferon (IFN) is necessary and sufficient for DC death both in vitro and in vivo, and that TLR3 and MAVS co-operate in IFNß production in vivo to induce DC death in response to PolyIC. CONCLUSIONS/SIGNIFICANCE: These results demonstrate for the first time in vivo that apoptosis restricts DC lifespan following activation by PolyIC, particularly affecting the CD8α cDC subset. Such DC apoptosis is mediated by the overlapping action of pro-apoptotic BH3-only proteins, including but not solely involving Bim, and is driven by Type I IFN. While Type I IFNs are important anti-viral factors, CD8α cDC are major cross-presenting cells and critical inducers of CTL. We discuss such paradoxical finding on DC death with PolyIC/Type I IFN. These results could contribute to understand immunosuppression associated with chronic infection, and to the optimization of DC-based therapies and the clinical use of PAMPs and Type I IFNs

Menjadi pribadi yang mengubah dunia = Signs of life

Buku ini akan membimbing anda dalam perjalanan menuju pemahaman yang lebih lengkap akan tanda-tanda yang menunjukkan bahwa Anda adalah orang Kristiani.Yogyakarta360 halaman ; 20 c

Estudio multicéntrico de ingesta de imanes en los servicios de urgencias pediátricos españoles

Ingestión; Imanes; Urgencias de pediatríaIngestion; Magnets; Paediatric emergenciesIngestió; Imants; Urgències de pediatriaIntroduction The ingestion of magnetic objects can cause complications in children, and there are no epidemiological or clinical data on the subject in Spain. Objectives To determine the incidence, epidemiological characteristics and management of magnet ingestion in paediatric emergency departments in Spain. Material and methods Prospective observational multicentre study conducted over a 3-year period. The study universe consisted of patients aged less than 14 years. Results The incidence was 4.8 cases per 100 000 emergency care episodes. Of the 72 patients included (mean age, 7.2 years), 54% were male. Seven percent had neuropsychiatric disorders. Sixty-one percent of the magnets were spherical and 69% came from toys. The size was variable, most frequently between 5 and 10 mm (50%), and ranging from 3 to 30 mm. Eighty-six percent of patients were asymptomatic. The most frequent symptom was abdominal pain. Eighty-three percent of the patients sought medical care within 6 h of ingestion and 92% within 24 h. Thirty-one percent of the cases were of multiple ingestion. Endoscopy was required for extraction in 15% of cases, a proportion that rose to 36% in the group of cases of multiple ingestion. None of the patients required surgery. We did not observe any gastrointestinal complications of magnet ingestion. Conclusions The ingestion of multiple magnets is less frequent than single magnet ingestion, and we did not observe any complications despite the lower frequency of procedures compared to other studies.Introducción Las ingestas de objetos imantados pueden presentar complicaciones en el niño, no existiendo datos epidemiológicos ni clínicos en España. Objetivos Conocer la incidencia de ingesta de objetos imantados en los Servicios de Urgencias Pediátricos Españoles, sus características epidemiológicas y su manejo. Material y métodos Estudio observacional prospectivo multicéntrico realizado durante 3 años. Población de referencia menores de 14 años. Resultados La incidencia fue de 4,8/100.000 urgencias. De los 72 pacientes incluidos (edad media de 7,2 años), el 54% fueron varones. El 7% presentaron antecedentes neuropsiquiátricos. El 61% de los imanes fueron esféricos y el 69% procedían de juguetes. El tamaño fue variable con un predominio de los imanes entre 5 y 10 mm (50%). El 86% fueron asintomáticos. El síntoma más frecuente fue el dolor abdominal. El 83% de los pacientes consultaron en menos de 6 horas y el 92% en las primeras 24 horas. El 31% fueron ingestas múltiples. El 15% precisó intervención endoscópica, cifra que ascendió al 36% en los casos de ingestas múltiples. No se realizó ninguna intervención quirúrgica. No se observó ninguna complicación gastrointestinal secundaria. Conclusiones Las ingestas de imanes múltiples son menos frecuentes que las simples y en este estudio no se han observado complicaciones a pesar de que las intervenciones realizadas han sido menores que en otros estudios.The study was funded through the 2016 annual grant of the Research Network of the Sociedad Española de Urgencias de Pediatría (RiSEUP-SPERG), for an amount of euro4000

SARS‐CoV‐2 acute bronchiolitis in hospitalized children: Neither frequent nor more severe

Introduction: Endemic coronaviruses have been found in acute bronchiolitis, mainly as a coinfecting virus. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been responsible for respiratory illness in hospitalized children. The characteristics of patients with bronchiolitis have not been extensively described. Methods: Cross-sectional study of patients with bronchiolitis and SARS-CoV-2 infection enrolled in a prospective multicenter cohort of children hospitalized with COVID-19 in Spain from March 1, 2020 to February 28, 2021. Results: Twelve of 666 children infected with SARS-CoV-2 who required hospital admission met the diagnostic criteria for bronchiolitis (1.8%). Median age was 1.9 months (range: 0.4-10.1). Six cases had household contact with a confirmed or probable COVID-19 case. Main complaints were cough (11 patients), rhinorrhea (10), difficulty breathing (8), and fever (8). Eleven cases were classified as mild or moderate and one as severe. Laboratory tests performed in seven patients did not evidence anemia, lymphopenia, or high C-reactive protein levels. Chest X-rays were performed in six children, and one case showed remarkable findings. Coinfection with metapneumovirus was detected in the patient with the most severe course; Bordetella pertussis was detected in another patient. Seven patients required oxygen therapy. Albuterol was administered in four patients. One patient was admitted to the pediatric intensive care unit. Median length of admission was 4 days (range: 3-14). No patient died or showed any sequelae at discharge. Two patients developed recurrent bronchospasms. Conclusion: SARS-CoV-2 infection does not seem to be a main trigger of severe bronchiolitis, and children with this condition should be managed according to clinical practice guidelines.Instituto de Salud Carlos III (Ministry of Economy, Industry and Competitiveness)4.090 JCR (2021) Q1, 21/130 Pediatrics0.927 SJR (2021) Q1, 49/320 Pediatrics, Perinatology and Child HealthNo data IDR 2021UE

Linking families and facilities for care at birth: What works to avert intrapartum-related deaths?

Background: Delays in receiving effective care during labor and at birth may be fatal for the mother and fetus, contributing to 2 million annual intrapartum stillbirths and intrapartum-related neonatal deaths each year. Objective: We present a systematic review of strategies to link families and facilities, including community mobilization, financial incentives, emergency referral and transport systems, prenatal risk screening, and maternity waiting homes. Results: There is moderate quality evidence that community mobilization with high levels of community engagement can increase institutional births and significantly reduce perinatal and early neonatal mortality. Meta-analysis showed a doubling of skilled birth attendance and a 36% reduction in early neonatal mortality. However, no data are available on intrapartum-specific outcomes. Evidence is limited, but promising, that financial incentive schemes and community referral/transport systems may increase rates of skilled birth attendance and emergency obstetric care utilization; however, impact on mortality is unknown. Current evidence for maternity waiting homes and risk screening is low quality. Conclusions: Empowering communities is an important strategy to reduce the large burden of intrapartum complications. Innovations are needed to bring the poor closer to obstetric care, such as financial incentives and cell phone technology. New questions need to be asked of "old" strategies such as risk screening and maternity waiting homes. The effect of all of these strategies on maternal and perinatal mortality, particularly intrapartum-related outcomes, requires further evaluation. (C) 2009 Published by Elsevier Ireland Ltd. on behalf of International Federation of Gynecology and Obstetrics

Desarrollo de sistemas de producción agrícola sostenible para el sector campesino de Los Andes de Centrales: Comentarios desde una perspectiva sociológica

Está dividido en 5 partes 1. Desarrollo de sistemas de producción agrícola sostenible para el sector campesino de Los Andes de Bolivia. 2. Desarrollo de sistemas de producción agrícola sostenible para el sector campesino de Los Andes de Colombia. 3. Desarrollo de sistemas de producción agrícola sostenible para el sector campesino de Los Andes de Ecuador. 4. Desarrollo de sistemas de producción agrícola sostenible para el sector campesino de Los Andes de Perú. 5. Desarrollo de sistemas de producción agrícola sostenible para el sector campesino de Los Andes de Centrales Comentarios desde una perspectiva sociológica.El presente documento contiene las contribuciones expuestas en el Seminario para el desarrollo de sistemas de producción agrícola sostenible para el sector campesino de los Los Andes Centrales, llevado acabo en Quito, Ecuador, del 18 - 18 de enero de 1996. El cual presenta una breve descripción de las características físico-biológicas y socioeconómicas, al igual que el papel de la tecnología en el desarrollo de producción en los Andes centrales: Bolivia, Colombia, Ecuador y Perú