Ritmo auricular bajo

Presentamos el hallazgo casual de una alteración electrocardiográfica compatible con ritmo auricular bajo en un reconocimiento médico para la aptitud deportiva de un paciente varón de 9 años. El ritmo auricular bajo es un ritmo ectópico que se puede encontrar en pacientes en edad pediátrica o deportistas. Se considera una variante de la normalidad pero debe realizarse un buen diagnóstico diferencial de patologías potencialmente graves

Pedagogia dell’infanzia tra passato e presente

Childhood is an age of life, a condition of existence whose specificity has not always been recognized and whose “quality” has been differently thought over time. The “images” of childhood and the ways of child care and education have changed. The study of history of childhood and childhood education is a lens that allows us to grasp the interweaving of the phenomenic dimension – the child in its concreteness and in his life contexts –, the symbolic one – the filters through which adults have read and interpreted childhood –, and the pedagogical one – theories, interventions, educational experiences –. In recent decades, the study of childhood and its education has been enriched by fruitful research paths, such as the history of childhood and the “educational costume”, the pedagogy of day-care centres and nursery schools, the debate on early childhood educationalservices quality, the support in specific educational areas (play, reading, expressive activities etc.), the training of adults who take care of children (parents, teachers), the particular declination of special education in relation to childhood, to name just a few. Not just that.. The debate on these issues has emerged from the narrow scope of the academy spreading widely and also defining itself in locations which are different from the traditional ones: not only educational institutions but also health and medical, juridical, extracurricular recreational agencies, media (print, film, advertising etc.). It should also be remembered that, in support of the child’s condition, important documents have been elaborated and disseminated aiming to elaborate and consolidate a culture of childhood and the protection of children’s rights. Last but not least, innovative experiences born “from below”, have contributed – and contribute – to the development of a theory of childhood education. It should not be forgotten, as a fundamental orientation, that the pedagogy of infancy, understood as a theory of early childhood education, must make a dialogue between theory and practice, “being” and having to be”, in an exchange that involves a plurality of actors, including the children themselves. The monographic issue presents some significant examples of these themes and these questions.L’infanzia è un’epoca della vita, una condizione dell’esistenza la cui specificitànon è sempre stata riconosciuta e la cui “qualità”, nel tempo, è stata diversamente pensata. Alle trasformazioni nell’immaginario si accompagnano altrettanti mutamenti nei modi di cura ed educazione infantile. Lo studio della storia dell’infanzia e della pedagogia dell’infanzia relativa al passato è una lente che ci permette di cogliere l’intreccio tra dimensione fenomenica – il bambino nella sua concretezza e nei suoi contesti di vita –, quella simbolica – i filtri attraverso cui gli adulti hanno letto e interpretato l’infanzia –, quella pedagogica – teorie, interventi, esperienze educative –. Negli ultimi decenni lo studio dell’infanzia e la sua pedagogia si è arricchito di fecondi percorsi di ricerca, quali la storia dell’infanzia e del “costume educativo”, la pedagogia del nido e della scuola dell’infanzia, il dibattito sulla qualità dei servizi per l’infanzia, la didattica in ambiti specifici (gioco, lettura, attività espressive ecc.), la formazione degli adulti che si occupano dei bambini (genitori, insegnanti), la particolare declinazione della pedagogia speciale in relazione all’età infantile,per citarne solo alcuni. Non solo. Il dibattito su questi temi è uscito dall’ambitoristretto dell’accademia e della dottrina diffondendosi ad ampio raggio e definendosi anche in sedi diverse da quelle tradizionali: non solo le istituzioni educative ma anche quelle sanitarie e mediche, giuridiche, ricreative extrascolastiche, i media (stampa, film, pubblicità ecc.). Va inoltre ricordato che, a sostegno della condizione infantile, importanti documenti sono stati elaborati e diffusi a sostegno di una cultura dell’infanzia e a tutela dei diritti dei bambini.Infine, ma non meno importante, a elaborare una pedagogia dell’infanzia hannocontribuito – e contribuiscono – esperienze nate “dal basso”, innovative e inedite.Non va infatti dimenticato, quale orientamento di fondo, che la pedagogiadell’infanzia, intesa come teoria dell’educazione infantile, deve mettere in dialogoteoria e prassi, “essere” e dover essere” in uno scambio che vede partecipi unapluralità di attori, tra i quali i bambini stessi. Di questi temi e di questi nodi ilnumero monografico presenta alcuni esempi significativi

Ritme auricular baix

Presentem la troballa casual d’una alteració electrocardiogràfica compatible amb ritme auricular baix en un reconeixement mèdic de l’aptitud esportiva d’un pacient home de 9 anys. El ritme auricular baix és un ritme ectòpic que es pot trobar en pacients d’edat pediàtrica o esportistes. Es considera una variant de la normalitat però cal fer un bon diagnòstic diferencial de patologies potencialment greus

Multicentre, randomised, open-label, phase IV–III study to evaluate the efficacy of cloxacillin plus fosfomycin versus cloxacillin alone in adult patients with methicillin-susceptible Staphylococcus aureus bacteraemia: study protocol for the SAFO trial

SAFO study group and the Spanish Network for Research in Infectious Diseases (REIPI).[Introduction] Methicillin-susceptible Staphylococcus aureus (MSSA) bacteraemia is a frequent condition, with high mortality rates. There is a growing interest in identifying new therapeutic regimens able to reduce therapeutic failure and mortality observed with the standard of care of beta-lactam monotherapy. In vitro and small-scale studies have found synergy between cloxacillin and fosfomycin against S. aureus. Our aim is to test the hypothesis that cloxacillin plus fosfomycin achieves higher treatment success than cloxacillin alone in patients with MSSA bacteraemia.[Methods] We will perform a superiority, randomised, open-label, phase IV–III, two-armed parallel group (1:1) clinical trial at 20 Spanish tertiary hospitals. Adults (≥18 years) with isolation of MSSA from at least one blood culture ≤72 hours before inclusion with evidence of infection, will be randomly allocated to receive either cloxacillin 2 g/4-hour intravenous plus fosfomycin 3 g/6-hour intravenous or cloxacillin 2 g/4-hour intravenous alone for 7 days. After the first week, sequential treatment and total duration of antibiotic therapy will be determined according to clinical criteria by the attending physician. Primary endpoints: (1) Treatment success at day 7, a composite endpoint comprising all the following criteria: patient alive, stable or with improved quick-Sequential Organ Failure Assessment score, afebrile and with negative blood cultures for MSSA at day 7. (2) Treatment success at test of cure (TOC) visit: patient alive and no isolation of MSSA in blood culture or at another sterile site from day 8 until TOC (12 weeks after randomisation). We assume a rate of treatment success of 74% in the cloxacillin group. Accepting alpha risk of 0.05 and beta risk of 0.2 in a two-sided test, 183 subjects will be required in each of the control and experimental groups to obtain statistically significant difference of 12% (considered clinically significant).[Ethics and dissemination] Ethical approval has been obtained from the Ethics Committee of Bellvitge University Hospital (AC069/18) and from the Spanish Medicines and Healthcare Product Regulatory Agency (AEMPS, AC069/18), and is valid for all participating centres under existing Spanish legislation. The results will be presented at international meetings and will be made available to patients and funders.[Trial registration number] The protocol has been approved by AEMPS with the Trial Registration Number EudraCT 2018-001207-37. ClinicalTrials.gov Identifier: NCT03959345; Pre-results.The SAFO trial is supported by a competitive grant awarded by the Fondo de Investigaciones Sanitarias at the Spanish government’s National Institute of Health Research, Instituto de Salud Carlos III (ISCIII), (FIS PI17/01116). This study was supported by Plan Nacional de I+D+i 2017–2021 and Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Economía, Industria y Competitividad, Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0005).Peer reviewe

Multicentre, randomised, open-label, phase IV-III study to evaluate the efficacy of cloxacillin plus fosfomycin versus cloxacillin alone in adult patients with methicillin-susceptible Staphylococcus aureus bacteraemia: study protocol for the SAFO trial

Introduction: Methicillin-susceptible Staphylococcus aureus (MSSA) bacteraemia is a frequent condition, with high mortality rates. There is a growing interest in identifying new therapeutic regimens able to reduce therapeutic failure and mortality observed with the standard of care of beta-lactam monotherapy. In vitro and small-scale studies have found synergy between cloxacillin and fosfomycin against S. aureus. Our aim is to test the hypothesis that cloxacillin plus fosfomycin achieves higher treatment success than cloxacillin alone in patients with MSSA bacteraemia. Methods: We will perform a superiority, randomised, open-label, phase IV-III, two-armed parallel group (1:1) clinical trial at 20 Spanish tertiary hospitals. Adults (≥18 years) with isolation of MSSA from at least one blood culture ≤72 hours before inclusion with evidence of infection, will be randomly allocated to receive either cloxacillin 2 g/4-hour intravenous plus fosfomycin 3 g/6-hour intravenous or cloxacillin 2 g/4-hour intravenous alone for 7 days. After the first week, sequential treatment and total duration of antibiotic therapy will be determined according to clinical criteria by the attending physician. Primary endpoints: (1) Treatment success at day 7, a composite endpoint comprising all the following criteria: patient alive, stable or with improved quick-Sequential Organ Failure Assessment score, afebrile and with negative blood cultures for MSSA at day 7. (2) Treatment success at test of cure (TOC) visit: patient alive and no isolation of MSSA in blood culture or at another sterile site from day 8 until TOC (12 weeks after randomisation). We assume a rate of treatment success of 74% in the cloxacillin group. Accepting alpha risk of 0.05 and beta risk of 0.2 in a two-sided test, 183 subjects will be required in each of the control and experimental groups to obtain statistically significant difference of 12% (considered clinically significant). Ethics and dissemination: Ethical approval has been obtained from the Ethics Committee of Bellvitge University Hospital (AC069/18) and from the Spanish Medicines and Healthcare Product Regulatory Agency (AEMPS, AC069/18), and is valid for all participating centres under existing Spanish legislation. The results will be presented at international meetings and will be made available to patients and funders

COVID Isolation Eating Scale (CIES): Analysis of the impact of confinement in eating disorders and obesity-A collaborative international study

Confinement during the COVID-19 pandemic is expected to have a serious and complex impact on the mental health of patients with an eating disorder (ED) and of patients with obesity. The present manuscript has the following aims: (1) to analyse the psychometric properties of the COVID Isolation Eating Scale (CIES), (2) to explore changes that occurred due to confinement in eating symptomatology; and (3) to explore the general acceptation of the use of telemedicine during confinement. The sample comprised 121 participants (87 ED patients and 34 patients with obesity) recruited from six different centres. Confirmatory Factor Analyses (CFA) tested the rational-theoretical structure of the CIES. Adequate goodness-of-fit was obtained for the confirmatory factor analysis, and Cronbach alpha values ranged from good to excellent. Regarding the effects of confinement, positive and negative impacts of the confinement depends of the eating disorder subtype. Patients with anorexia nervosa (AN) and with obesity endorsed a positive response to treatment during confinement, no significant changes were found in bulimia nervosa (BN) patients, whereas Other Specified Feeding or Eating Disorder (OSFED) patients endorsed an increase in eating symptomatology and in psychopathology. Furthermore, AN patients expressed the greatest dissatisfaction and accommodation difficulty with remote therapy when compared with the previously provided face-to-face therapy. The present study provides empirical evidence on the psychometric robustness of the CIES tool and shows that a negative confinement impact was associated with ED subtype, whereas OSFED patients showed the highest impairment in eating symptomatology and in psychopathology.This manuscript and research was supported by grants from the Ministeriode Economía y Competitividad (PSI2015-68701-R), Instituto de Salud Carlos III (ISCIII) (FIS PI14/00290/ INT19/00046nd PI17/01167) and co-funded by FEDER funds/European Regional Development Fund (ERDF), a way to build Europe. CIBERobn, CIBERsam and CIBERDEM are all initiatives of ISCIII. GMB is supported by a postdoctoral grant from FUNCIVA. This initiative is supported by Generalitat de Catalunya. LM is supported by a postdoctoral grant of the mexican institution Consejo Nacional de Ciencia y Tecnología (CONACYT). PPM was supported, in part, by a Portuguese Foundation for Science and Technology grant (POCI-01-0145-FEDER-028145). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript

Impact of COVID-19 Lockdown in Eating Disorders: A Multicentre Collaborative International Study

Background. The COVID-19 lockdown has had a significant impact on mental health. Patients with eating disorders (ED) have been particularly vulnerable. Aims. (1) To explore changes in eating-related symptoms and general psychopathology during lockdown in patients with an ED from various European and Asian countries; and (2) to assess differences related to diagnostic ED subtypes, age, and geography. Methods. The sample comprised 829 participants, diagnosed with an ED according to DSM-5 criteria from specialized ED units in Europe and Asia. Participants were assessed using the COVID-19 Isolation Scale (CIES). Results. Patients with binge eating disorder (BED) experienced the highest impact on weight and ED symptoms in comparison with other ED subtypes during lockdown, whereas individuals with other specified feeding and eating disorders (OFSED) had greater deterioration in general psychological functioning than subjects with other ED subtypes. Finally, Asian and younger individuals appeared to be more resilient. Conclusions. The psychopathological changes in ED patients during the COVID-19 lockdown varied by cultural context and individual variation in age and ED diagnosis. Clinical services may need to target preventive measures and adapt therapeutic approaches for the most vulnerable patients