Utilitat d'una prova ràpida per determinar la proteïna C reactiva (QuikRead go® CRP) en el maneig del lactant amb febre sense focus a urgències

The C-reactive protein (CRP) is useful in the management of infants with fever without source (FWS) as it may help identify those at high risk of potentially serious bacterial infection SBI). Methods for bedside CRP testing are now available

Utilitat de la tomografia computada davant la sospita de cel·lulitis orbitària a urgències

Fonament. La cel·lulitis orbitària (CO) és un diagnòstic de sospita clínica que requereix confirmació radiològica. És habitual l'ingrés amb tractament antibiòtic a l'espera de la confirmació diagnòstica. Objectiu. Avaluar el possible impacte de la realització d'una tomografia computada (TC) en el maneig a Urgències del pacient amb sospita de CO. Mètode. Estudi retrospectiu, descriptiu-observacional. Es van revisar les històries clíniques dels pacients atesos a Urgències entre 2011 i 2014 amb diagnòstic de cel·lulitis periorbitària/orbitària. Es van incloure els casos amb sospita de CO. Es van excloure els pacients sense TC. Es defineix CO com la cel·lulitis que afecta més enllà del septe orbitari. Es van considerar criteris d'ingrés: edat <1 any, immunosupressió, vacunació incompleta, triangle d'avaluació pediàtrica (TAP) alterat, mala resposta antibiòtica i presència d'algun dels símptomes o signes oculars següents: dolor amb els moviments oculars, oftalmoplegia, disminució de l'agudesa visual, alteració dels reflexos pupil·lars, edema conjuntival i proptosi. Resultats. Es van incloure 85 pacients. Tots van ser immunocompetents, ben vacunats i presentaven un TAP normal. Vint (23,5%) presentaven un o més signes o símptomes oculars. Vint-i-set (31,8%) tenien un o més criteris d'ingrés. Dels 58 sense criteris d'ingrés, en 38 (65,5%) no es va confirmar CO. A 18 (31%) d'aquests pacients se'ls va fer TC a Urgències; en 13 casos es va indicar maneig ambulatori, ja que l'afectació era només preseptal. Es va confirmar CO en 34 pacients (concordança diagnòstica 40%). Conclusions. En més de la meitat dels pacients amb sospita de CO, aquesta no es confirma radiològicament. Fer una TC a Urgències, en els pacients que no tenen criteris d'ingrés, evitaria hospitalitzacions innecessàries en un nombre significatiu

Serotypes and Clonal Diversity of Streptococcus pneumoniae Causing Invasive Disease in the Era of PCV13 in Catalonia, Spain

The aim of this study was to study the serotypes and clonal diversity of pneumococci causing invasive pneumococcal disease in Catalonia, Spain, in the era of 13-valent pneumococcal conjugate vaccine (PCV13). In our region, this vaccine is only available in the private market and it is estimated a PCV13 vaccine coverage around 55% in children. A total of 1551 pneumococcal invasive isolates received between 2010 and 2013 in the Molecular Microbiology Department at Hospital Sant Joan de Déu, Barcelona, were included. Fifty-two serotypes and 249 clonal types defined by MLST were identified. The most common serotypes were serotype 1 (n = 182; 11.7%), 3 (n = 145; 9.3%), 19A (n = 137; 8.8%) and 7F (n = 122; 7.9%). Serotype 14 was the third most frequent serotype in children < 2 years (15 of 159 isolates). PCV7 serotypes maintained their proportion along the period of study, 16.6% in 2010 to 13.4% in 2013, whereas there was a significant proportional decrease in PCV13 serotypes, 65.3% in 2010 to 48.9% in 2013 (p<0.01). This decrease was mainly attributable to serotypes 19A and 7F. Serotype 12F achieved the third position in 2013 (n = 22, 6.4%). The most frequent clonal types found were ST306 (n = 154, 9.9%), ST191 (n = 111, 7.2%), ST989 (n = 85, 5.5%) and ST180 (n = 80, 5.2%). Despite their decrease, PCV13 serotypes continue to be a major cause of disease in Spain. These results emphasize the need for complete PCV13 vaccination

CIBERER : Spanish national network for research on rare diseases: A highly productive collaborative initiative

Altres ajuts: Instituto de Salud Carlos III (ISCIII); Ministerio de Ciencia e Innovación.CIBER (Center for Biomedical Network Research; Centro de Investigación Biomédica En Red) is a public national consortium created in 2006 under the umbrella of the Spanish National Institute of Health Carlos III (ISCIII). This innovative research structure comprises 11 different specific areas dedicated to the main public health priorities in the National Health System. CIBERER, the thematic area of CIBER focused on rare diseases (RDs) currently consists of 75 research groups belonging to universities, research centers, and hospitals of the entire country. CIBERER's mission is to be a center prioritizing and favoring collaboration and cooperation between biomedical and clinical research groups, with special emphasis on the aspects of genetic, molecular, biochemical, and cellular research of RDs. This research is the basis for providing new tools for the diagnosis and therapy of low-prevalence diseases, in line with the International Rare Diseases Research Consortium (IRDiRC) objectives, thus favoring translational research between the scientific environment of the laboratory and the clinical setting of health centers. In this article, we intend to review CIBERER's 15-year journey and summarize the main results obtained in terms of internationalization, scientific production, contributions toward the discovery of new therapies and novel genes associated to diseases, cooperation with patients' associations and many other topics related to RD research

Pro-adrenomedullin usefulness in the management of children with community-acquired pneumonia, a preliminary prospective observational study

BackgroundIn adult population with community acquired pneumonia high levels of pro-adrenomedullin (pro-ADM) have been shown to be predictors of worse prognosis. The role of this biomarker in pediatric patients had not been analyzed to date. The objective of this study is to know the levels of pro-ADM in children with community acquired pneumonia (CAP) and analyze the relation between these levels and the patients¿ prognosis.FindingsProspective observational study including patients attended in the emergency service (January to October 2009) admitted to hospital with CAP and no complications at admission. The values for pro-ADM were analyzed in relation to: need for oxygen therapy, duration of oxygen therapy, fever and antibiotic therapy, complications, admission to the intensive care unit, and length of hospital stay. Fifty patients were included. Ten presented complications (7 pleural effusion). The median level of pro-ADM was 1.0065¿nmol/L (range 0.3715 to 7.2840¿nmol/L). The patients presenting complications had higher levels of pro-ADM (2.3190 vs. 1.1758¿nmol/L, p¿=¿0.013). Specifically, the presence of pleural effusion was associated with higher levels of pro-ADM (2.9440 vs. 1.1373¿nmol/L, p¿<¿0.001).ConclusionsIn our sample of patients admitted to hospital with CAP, pro-ADM levels are related to the development of complications during hospitalization

Pro-adrenomedullin usefulness in the management of children with community-acquired pneumonia, a preliminary prospective observational study

BackgroundIn adult population with community acquired pneumonia high levels of pro-adrenomedullin (pro-ADM) have been shown to be predictors of worse prognosis. The role of this biomarker in pediatric patients had not been analyzed to date. The objective of this study is to know the levels of pro-ADM in children with community acquired pneumonia (CAP) and analyze the relation between these levels and the patients¿ prognosis.FindingsProspective observational study including patients attended in the emergency service (January to October 2009) admitted to hospital with CAP and no complications at admission. The values for pro-ADM were analyzed in relation to: need for oxygen therapy, duration of oxygen therapy, fever and antibiotic therapy, complications, admission to the intensive care unit, and length of hospital stay. Fifty patients were included. Ten presented complications (7 pleural effusion). The median level of pro-ADM was 1.0065¿nmol/L (range 0.3715 to 7.2840¿nmol/L). The patients presenting complications had higher levels of pro-ADM (2.3190 vs. 1.1758¿nmol/L, p¿=¿0.013). Specifically, the presence of pleural effusion was associated with higher levels of pro-ADM (2.9440 vs. 1.1373¿nmol/L, p¿<¿0.001).ConclusionsIn our sample of patients admitted to hospital with CAP, pro-ADM levels are related to the development of complications during hospitalization

Utilitat d'una prova ràpida per determinar la proteïna C reactiva (QuikRead go® CRP) en el maneig del lactant amb febre sense focus a urgències

The C-reactive protein (CRP) is useful in the management of infants with fever without source (FWS) as it may help identify those at high risk of potentially serious bacterial infection SBI). Methods for bedside CRP testing are now available

Utilitat de la tomografia computada davant la sospita de cel·lulitis orbitària a urgències

Fonament. La cel·lulitis orbitària (CO) és un diagnòstic de sospita clínica que requereix confirmació radiològica. És habitual l'ingrés amb tractament antibiòtic a l'espera de la confirmació diagnòstica. Objectiu. Avaluar el possible impacte de la realització d'una tomografia computada (TC) en el maneig a Urgències del pacient amb sospita de CO. Mètode. Estudi retrospectiu, descriptiu-observacional. Es van revisar les històries clíniques dels pacients atesos a Urgències entre 2011 i 2014 amb diagnòstic de cel·lulitis periorbitària/orbitària. Es van incloure els casos amb sospita de CO. Es van excloure els pacients sense TC. Es defineix CO com la cel·lulitis que afecta més enllà del septe orbitari. Es van considerar criteris d'ingrés: edat <1 any, immunosupressió, vacunació incompleta, triangle d'avaluació pediàtrica (TAP) alterat, mala resposta antibiòtica i presència d'algun dels símptomes o signes oculars següents: dolor amb els moviments oculars, oftalmoplegia, disminució de l'agudesa visual, alteració dels reflexos pupil·lars, edema conjuntival i proptosi. Resultats. Es van incloure 85 pacients. Tots van ser immunocompetents, ben vacunats i presentaven un TAP normal. Vint (23,5%) presentaven un o més signes o símptomes oculars. Vint-i-set (31,8%) tenien un o més criteris d'ingrés. Dels 58 sense criteris d'ingrés, en 38 (65,5%) no es va confirmar CO. A 18 (31%) d'aquests pacients se'ls va fer TC a Urgències; en 13 casos es va indicar maneig ambulatori, ja que l'afectació era només preseptal. Es va confirmar CO en 34 pacients (concordança diagnòstica 40%). Conclusions. En més de la meitat dels pacients amb sospita de CO, aquesta no es confirma radiològicament. Fer una TC a Urgències, en els pacients que no tenen criteris d'ingrés, evitaria hospitalitzacions innecessàries en un nombre significatiu

Clinical Prediction Rule for Distinguishing Bacterial From Aseptic Meningitis.

New biomarkers like procalcitonin and C-reactive protein may help design an accurate decision support tool used to identify children with pleocytosis at low or high risk of bacterial meningitis. Our objective was to develop and validate a score (that we call the meningitis score for emergencies [MSE]) to distinguish bacterial meningitis from aseptic meningitis in children with pleocytosis when initially evaluated at the emergency department. We included children between 29 days and 14 years old with meningitis admitted to 25 Spanish emergency departments. A retrospective cohort from between 2011 and 2016 was used as the derivation set and a prospective cohort recruited during 2017 and 2018 was used as the validation set. Among the 1009 patients included, there were 917 cases of aseptic meningitis and 92 of bacterial meningitis. Using multivariable logistic regression analysis, we identified the following predictors of bacterial meningitis from the derivation set: procalcitonin >1.2 ng/mL, cerebrospinal fluid (CSF) protein >80 mg/dL, CSF absolute neutrophil count >1000 cells per mm3, and C-reactive protein >40 mg/L. Using the derivation set, we developed the MSE, assigning 3 points for procalcitonin, 2 points for CSF protein, and 1 point for each of the other variables. An MSE ≥1 predicted bacterial meningitis with a sensitivity of 100% (95% confidence interval [CI]: 95.0%-100%), a specificity of 83.2 (95% CI: 80.6-85.5), and a negative predictive value of 100% (95% CI 99.4-100.) CONCLUSIONS: The MSE accurately distinguishes bacterial from aseptic meningitis in children with CSF pleocytosis