Sexually transmitted diseases in pediatric emergency care

Determinar les característiques dels pacients diag- nosticats de malalties de transmissió sexual (MTS) a urgèn- cies i establir la freqüència en què són degudes a abús sexual. Mètode. Estudi retrospectiu fet entre el gener del 2007 i el desembre del 2011. S'inclouen els pacients menors de 18 anys diagnosticats a urgències d'MTS -infecció per Neisse- ria gonorrhoeae, Chlamydia trachomatis, Treponema palli- dum, , virus d'immunodeficiència humana (VIH), virus del pa- pil loma humà (VPH) i virus herpes simple tipus 2 (VHS-2)-. Resultats. S'han trobat 28 pacients (6 casos / 100.000 vi- sites); mediana d'edat 15,9 anys (p. 25-75: 13,9-17,5); tots adolescents excepte 4, menors de 7 anys; 23 (82,1%) de sexe femení. Els motius de consulta són: 8 (28,6%) lesions cutànies, 6 (21,4%) secreció vaginal/uretral, 6 (21,4%) dolor abdominal, 1 (3,6%) febre, 1 (3,6%) pro- miscuïtat, 1 (3,6%) nàusees i vòmits i 5 (17,9%) infecció asimptomàtica. En 8 casos (28,6%) el motiu incloïa la sos- pita d'abús sexual (3 remesos pel pediatre i 5 per mani- festació del menor). Tretze casos (46,4%) són valorats con- juntament amb Ginecologia, 6 (21,4%) amb Dermatologia i 11 (39,3%) amb la Unitat Funcional d'Abús al Menor de l'Hospital. Es diagnostiquen microbiològicament 10 (35,7%) infeccions per N. Gonorrhoeae, , 6 (21,4%) per C. Trachomatis , 6 (21,4%) per VPH, 3 (10,7%) per VIH, 2 (7,2%) per VHS-2 i 2 (7,2%) per T. Pallidum. Una adoles- cent amb malaltia inflamatòria pèlvica presenta coinfecció per N. Gonorrhoeae i C.. trachomatis. . Finalment es diagnos- tiquen d'abús sexual 10 pacients (35,7%). Conclusions. Els diagnòstics d'MTS a Urgències es donen bàsicament en adolescents; en infants petits cal sospitar abús. Malgrat que són molt poc freqüents, és important conèixer els signes guia per poder fer un diagnòstic precoç i minimitzar-ne les conseqüències

Tuberculosis in pediatric patients treated with anti-TNFα drugs: a cohort study

Background: Adult patients receiving anti-TNFα drugs are at increased risk of tuberculosis (TB), but studies in pediatric populations are limited, and the best strategy for latent tuberculosis infection (LTBI) screening in this population remains controversial. We describe the prevalence of LTBI prior to anti-TNFα therapy and the long-term follow-up after biological treatment initiation in a cohort of children and adolescents. Methods: Cohort observational study in children and adolescents receiving anti-TNFα agents in a tertiary-care pediatric hospital. LTBI was ruled out prior to the implementation of anti-TNFα drugs by tuberculin skin test (TST), and, from March 2012 on, QuantiFERON Gold-In Tube® test (QTF-G). During anti-TNFα treatment, patients were evaluated every 6 months for TB with history and physical examination. TST/QTF-G were not repeated unless signs or symptoms consistent with TB arose or there was proven TB contact. Results: The final cohort consisted of 221 patients (56.1 % female; 261 treatments), of whom 51.7 %/30.0 %/17.3 % were treated with etanercept/adalimumab/infliximab, respectively, for a variety of rheumatic diseases (75.6 %), inflammatory bowel disease (20.8 %), and inflammatory eye diseases (3.6 %). The median (IQR) age at diagnosis of the primary condition was 6.8 years (2.7-11.0) and the duration of the disease before implementing the anti-TNFα agent was 1.8 years (0.6-4.2). LTBI was diagnosed in 3 adolescent girls (prevalence rate: 1.4 %; 95 % CI: 0.4-4.2) affected with juvenile idiopathic arthritis: TST tested positive in only 1, while QTF-G was positive in all cases (including 2 patients already on etanercept). They all received antiTB chemoprophylaxis and were later (re)treated with etanercept for 24-29 months, without incidences. No incident cases of TB disease were observed during the follow-up period under anti-TNFα treatment of 641 patients-year, with a median (IQR) time per patient of 2.3 years (1.4-4.3). Conclusions: In our study, the prevalence of LTBI (1.4 %) was similar to that reported in population screening studies in Spain; no incident cases of TB disease were observed. In low-burden TB settings, initial screening for TB in children prior to anti-TNFα treatment should include both TST and an IGRA test, but systematic repetition of LTBI immunodiagnostic tests seems unnecessary in the absence of symptoms or known TB contact

Prospective individual patient data meta-analysis of two randomized trials on convalescent plasma for COVID-19 outpatients

Data on convalescent plasma (CP) treatment in COVID-19 outpatients are scarce. We aimed to assess whether CP administered during the first week of symptoms reduced the disease progression or risk of hospitalization of outpatients. Two multicenter, double-blind randomized trials (NCT04621123, NCT04589949) were merged with data pooling starting when = 50 years and symptomatic for <= 7days were included. The intervention consisted of 200-300mL of CP with a predefined minimum level of antibodies. Primary endpoints were a 5-point disease severity scale and a composite of hospitalization or death by 28 days. Amongst the 797 patients included, 390 received CP and 392 placebo; they had a median age of 58 years, 1 comorbidity, 5 days symptoms and 93% had negative IgG antibody-test. Seventy-four patients were hospitalized, 6 required mechanical ventilation and 3 died. The odds ratio (OR) of CP for improved disease severity scale was 0.936 (credible interval (CI) 0.667-1.311); OR for hospitalization or death was 0.919 (CI 0.592-1.416). CP effect on hospital admission or death was largest in patients with <= 5 days of symptoms (OR 0.658, 95%CI 0.394-1.085). CP did not decrease the time to full symptom resolution

Sexually transmitted diseases in pediatric emergency care

Determinar les característiques dels pacients diag- nosticats de malalties de transmissió sexual (MTS) a urgèn- cies i establir la freqüència en què són degudes a abús sexual. Mètode. Estudi retrospectiu fet entre el gener del 2007 i el desembre del 2011. S'inclouen els pacients menors de 18 anys diagnosticats a urgències d'MTS -infecció per Neisse- ria gonorrhoeae, Chlamydia trachomatis, Treponema palli- dum, , virus d'immunodeficiència humana (VIH), virus del pa- pil loma humà (VPH) i virus herpes simple tipus 2 (VHS-2)-. Resultats. S'han trobat 28 pacients (6 casos / 100.000 vi- sites); mediana d'edat 15,9 anys (p. 25-75: 13,9-17,5); tots adolescents excepte 4, menors de 7 anys; 23 (82,1%) de sexe femení. Els motius de consulta són: 8 (28,6%) lesions cutànies, 6 (21,4%) secreció vaginal/uretral, 6 (21,4%) dolor abdominal, 1 (3,6%) febre, 1 (3,6%) pro- miscuïtat, 1 (3,6%) nàusees i vòmits i 5 (17,9%) infecció asimptomàtica. En 8 casos (28,6%) el motiu incloïa la sos- pita d'abús sexual (3 remesos pel pediatre i 5 per mani- festació del menor). Tretze casos (46,4%) són valorats con- juntament amb Ginecologia, 6 (21,4%) amb Dermatologia i 11 (39,3%) amb la Unitat Funcional d'Abús al Menor de l'Hospital. Es diagnostiquen microbiològicament 10 (35,7%) infeccions per N. Gonorrhoeae, , 6 (21,4%) per C. Trachomatis , 6 (21,4%) per VPH, 3 (10,7%) per VIH, 2 (7,2%) per VHS-2 i 2 (7,2%) per T. Pallidum. Una adoles- cent amb malaltia inflamatòria pèlvica presenta coinfecció per N. Gonorrhoeae i C.. trachomatis. . Finalment es diagnos- tiquen d'abús sexual 10 pacients (35,7%). Conclusions. Els diagnòstics d'MTS a Urgències es donen bàsicament en adolescents; en infants petits cal sospitar abús. Malgrat que són molt poc freqüents, és important conèixer els signes guia per poder fer un diagnòstic precoç i minimitzar-ne les conseqüències

Tuberculosis in pediatric patients treated with anti-TNFα drugs: a cohort study

Background: Adult patients receiving anti-TNFα drugs are at increased risk of tuberculosis (TB), but studies in pediatric populations are limited, and the best strategy for latent tuberculosis infection (LTBI) screening in this population remains controversial. We describe the prevalence of LTBI prior to anti-TNFα therapy and the long-term follow-up after biological treatment initiation in a cohort of children and adolescents. Methods: Cohort observational study in children and adolescents receiving anti-TNFα agents in a tertiary-care pediatric hospital. LTBI was ruled out prior to the implementation of anti-TNFα drugs by tuberculin skin test (TST), and, from March 2012 on, QuantiFERON Gold-In Tube® test (QTF-G). During anti-TNFα treatment, patients were evaluated every 6 months for TB with history and physical examination. TST/QTF-G were not repeated unless signs or symptoms consistent with TB arose or there was proven TB contact. Results: The final cohort consisted of 221 patients (56.1 % female; 261 treatments), of whom 51.7 %/30.0 %/17.3 % were treated with etanercept/adalimumab/infliximab, respectively, for a variety of rheumatic diseases (75.6 %), inflammatory bowel disease (20.8 %), and inflammatory eye diseases (3.6 %). The median (IQR) age at diagnosis of the primary condition was 6.8 years (2.7-11.0) and the duration of the disease before implementing the anti-TNFα agent was 1.8 years (0.6-4.2). LTBI was diagnosed in 3 adolescent girls (prevalence rate: 1.4 %; 95 % CI: 0.4-4.2) affected with juvenile idiopathic arthritis: TST tested positive in only 1, while QTF-G was positive in all cases (including 2 patients already on etanercept). They all received antiTB chemoprophylaxis and were later (re)treated with etanercept for 24-29 months, without incidences. No incident cases of TB disease were observed during the follow-up period under anti-TNFα treatment of 641 patients-year, with a median (IQR) time per patient of 2.3 years (1.4-4.3). Conclusions: In our study, the prevalence of LTBI (1.4 %) was similar to that reported in population screening studies in Spain; no incident cases of TB disease were observed. In low-burden TB settings, initial screening for TB in children prior to anti-TNFα treatment should include both TST and an IGRA test, but systematic repetition of LTBI immunodiagnostic tests seems unnecessary in the absence of symptoms or known TB contact

Métodos de innovación docente aplicados a los estudios de Ciencias de la Comunicación

Se analiza el fenómeno de la implantación del Espacio Europeo de Educación Superior (EEES) a los estudios de Ciencias de la Comunicación, desde el punto de vista del profesorado. En este sentido se analizan experiencias educativas como: cuadernos de visionado para la iniciación de los alumnos en el comentario fílmico; la utilización didáctica de recursos audiovisuales; el uso de películas como herramientas en la educación de estudiantes; el uso de la televisión informativa; y la aplicación de técnicas de aprendizaje colaborativo entre otras propuestas. Asimismo, se estudia el estado de implantación del EEES en España y se describen propuestas de aplicación del mismo a diferentes áreas de los estudios de Ciencias de la Comunicación. También se dedican estudios a la descripción de nuevas estrategias docentes en el marco del EEES y se proponen fórmulas de evaluación de los aprendizajes. Por último se presta atención a la aplicación de las Tecnologías de la Información y la Comunicación a los citados estudios y se definen nuevas herramientas para apoyar a los estudiantes en su labor.MadridBiblioteca de Educación del Ministerio de Educación, Cultura y Deporte; Calle San Agustín 5 -3 Planta; 28014 Madrid; Tel. +34917748000; [email protected]