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.

Is the 23-valent pneumococcal polysaccharide vaccine useful in preventing community-acquired pneumonia?

Although bacteremic pneumococcal pneumonia is the most severe form of pneumonia, non-bacteremic forms are much more frequent. Laboratory methods for the diagnosis of nonbacteremic pneumococcal pneumonia have a low sensitivity and specificity, and therefore all-cause pneumonia has been proposed as a suitable outcome to evaluate vaccination effectiveness. This work reviews the epidemiology of community-acquired pneumonia (CAP) and evaluates the effectiveness of the 3-valent pneumococcal polysaccharide vaccine (PPV-23) in preventing CAP requiring hospitalization in people aged ≥65 years. We performed a case-control study in patients aged ≥65 years admitted through the emergency department who presented with clinical signs and symptoms compatible with pneumonia. Weincluded 489 cases and 1,467 controls and it was obtained a vaccine efectiveness of 23.6 (0.9-41.0). Our results suggest that PPV-23 vaccination is effective and reduces hospital admissions due to pneumonia in the elderly, strengthening the rationale for vaccination programmes in this age group.

Effect of maternal clinical chorioamnionitis on neonatal morbidity in very-low birthweight infants: a case control study

Aims: To assess the relationship between maternal clinical chorioamnionitis and neonatal outcome in preterm very-low birthweight (VLBW) infants. Methods: An observational case-control study was conducted in the Neonatology Services of 12 acute-care teaching hospitals in Spain. Between January 2004 and December 2006, all consecutive VLBW (F1500 g) infants born to a mother with clinical chorioamnionitis were enrolled. Controls were infants without chorioamnionitis matched by gestational age who were born immediately after each index case. Results: There were 165 cases and 163 controls. A significantly higher percentage of cases than controls required intubation (53% vs. 35.8%), had normal intrauterine growth (98.1% vs. 84.7%), were born in a tertiary center (inborn) (95.1% vs. 89.1%), from single gestations (76.4% vs. 65.6%) and vaginal delivery (47.3% vs. 33.3%), showed a lowerApgar score at 5 min, and presented a higher rate of earlyonset sepsis (10.4% vs. 1.2%). Older maternal age (32.5 vs. 30.8 years), premature labor (67.3% vs. 25.8%), premature rupture of membranes (61.3% vs. 25.8%), and antibiotic treatment (88.5% vs. 52.3%) were significantly more frequent among cases than controls. Conclusions: After controlling by gestational age, maternal chorioamnionitis was associated with neonatal depression and early sepsis but not with other prematurity-related complications.

How do we make the (right) diagnosis of acute appendicitis?

Objectives: To evaluate the correct diagnosis in unselected patients presenting withsuspected acute appendicitis in the Emergency Department in Hospital Trueta. To evaluate the different scenarios to achieve the correct diagnosis in patients with suspected acute appendicitis estimated by clinical evaluation without imaging, US only, CT only or US in all patients followed by CT after a non-diagnostic US.Design: Cross-sectional study conducted between April 2014 and March 2015.Settings: Medium-sized teaching hospital in Girona.Participants: Consecutive adult patients, 14 years old or older, with clinically suspectedacute appendicitis evaluated at the emergency department.Main outcome: Correct diagnosis of acute appendicitis

Effect of maternal clinical chorioamnionitis on neonatal morbidity in very-low birthweight infants: a case control study

Aims: To assess the relationship between maternal clinical chorioamnionitis and neonatal outcome in preterm very-low birthweight (VLBW) infants. Methods: An observational case-control study was conducted in the Neonatology Services of 12 acute-care teaching hospitals in Spain. Between January 2004 and December 2006, all consecutive VLBW (F1500 g) infants born to a mother with clinical chorioamnionitis were enrolled. Controls were infants without chorioamnionitis matched by gestational age who were born immediately after each index case. Results: There were 165 cases and 163 controls. A significantly higher percentage of cases than controls required intubation (53% vs. 35.8%), had normal intrauterine growth (98.1% vs. 84.7%), were born in a tertiary center (inborn) (95.1% vs. 89.1%), from single gestations (76.4% vs. 65.6%) and vaginal delivery (47.3% vs. 33.3%), showed a lowerApgar score at 5 min, and presented a higher rate of earlyonset sepsis (10.4% vs. 1.2%). Older maternal age (32.5 vs. 30.8 years), premature labor (67.3% vs. 25.8%), premature rupture of membranes (61.3% vs. 25.8%), and antibiotic treatment (88.5% vs. 52.3%) were significantly more frequent among cases than controls. Conclusions: After controlling by gestational age, maternal chorioamnionitis was associated with neonatal depression and early sepsis but not with other prematurity-related complications.

Effect of maternal clinical chorioamnionitis on neonatal morbidity in very-low birthweight infants: a case control study

Aims: To assess the relationship between maternal clinical chorioamnionitis and neonatal outcome in preterm very-low birthweight (VLBW) infants. Methods: An observational case-control study was conducted in the Neonatology Services of 12 acute-care teaching hospitals in Spain. Between January 2004 and December 2006, all consecutive VLBW (F1500 g) infants born to a mother with clinical chorioamnionitis were enrolled. Controls were infants without chorioamnionitis matched by gestational age who were born immediately after each index case. Results: There were 165 cases and 163 controls. A significantly higher percentage of cases than controls required intubation (53% vs. 35.8%), had normal intrauterine growth (98.1% vs. 84.7%), were born in a tertiary center (inborn) (95.1% vs. 89.1%), from single gestations (76.4% vs. 65.6%) and vaginal delivery (47.3% vs. 33.3%), showed a lowerApgar score at 5 min, and presented a higher rate of earlyonset sepsis (10.4% vs. 1.2%). Older maternal age (32.5 vs. 30.8 years), premature labor (67.3% vs. 25.8%), premature rupture of membranes (61.3% vs. 25.8%), and antibiotic treatment (88.5% vs. 52.3%) were significantly more frequent among cases than controls. Conclusions: After controlling by gestational age, maternal chorioamnionitis was associated with neonatal depression and early sepsis but not with other prematurity-related complications.

Is the 23-valent pneumococcal polysaccharide vaccine useful in preventing community-acquired pneumonia?

Although bacteremic pneumococcal pneumonia is the most severe form of pneumonia, non-bacteremic forms are much more frequent. Laboratory methods for the diagnosis of nonbacteremic pneumococcal pneumonia have a low sensitivity and specificity, and therefore all-cause pneumonia has been proposed as a suitable outcome to evaluate vaccination effectiveness. This work reviews the epidemiology of community-acquired pneumonia (CAP) and evaluates the effectiveness of the 3-valent pneumococcal polysaccharide vaccine (PPV-23) in preventing CAP requiring hospitalization in people aged ≥65 years. We performed a case-control study in patients aged ≥65 years admitted through the emergency department who presented with clinical signs and symptoms compatible with pneumonia. Weincluded 489 cases and 1,467 controls and it was obtained a vaccine efectiveness of 23.6 (0.9-41.0). Our results suggest that PPV-23 vaccination is effective and reduces hospital admissions due to pneumonia in the elderly, strengthening the rationale for vaccination programmes in this age group.

Análisis y creación de un sistema informático de soporte a entidades sanitarias para la detección precoz de brotes de gripe en épocas de máximo riesgo.

Hoy en día, las posibilidades del Big Data son incontables. Existe gran cantidad de información generada por la población general y disponible de forma pública.El reto consiste en poder trabajar con esta información y extraer conclusiones útiles y que generen valor.En este proyecto, queremos analizar en el tiempo el interés general de la población respecto a una enfermedad común como la gripe, y poder relacionarlos con brotes de gripe existentes en el pasado, para de esta manera, poder extrapolar y predecir futuros brotes.Esta información, en manos de las autoridades sanitarias, puede ser de gran ayuda para poder prevenir picos de solicitudes en los servicios de urgencias, anticipándose para gestionar de manera más eficaz los recursos disponibles, consiguiendo, de esta manera, un mejor servicio a la población en general.De esta manera, son los propios usuarios los que, sin saberlo, posibilitan una mayor y mejor respuesta en los servicios sanitarios mediante la información que ellos mismos distribuyen libremente, consiguiéndose de esta manera valiosos beneficios para la población general.

Análisis y creación de un sistema informático de soporte a entidades sanitarias para la detección precoz de brotes de gripe en épocas de máximo riesgo

En este proyecto queremos analizar en el tiempo el interés general de la población respecto a una enfermedad común como la gripe, y poder relacionarlos con brotes de gripe existentes en el pasado, para de esta manera, poder extrapolar y predecir futuros brotes. Esta información, en manos de las autoridades sanitarias, puede ser de gran ayuda para poder prevenir picos de solicitudes en los servicios de urgencias, anticipándose para gestionar de manera más eficaz los recursos disponibles, consiguiendo, de esta manera, un mejor servicio a la población en general.

A look to the HyMeX program (Una mirada al programa HyMeX)

The international HyMeX (Hydrological Mediterranean Experiment) program aims to improve our understanding of the water cycle in the Mediterranean, using a multidisciplinary and multiscale approach and with emphasis on extreme events. This program will improve our understanding and our predictive ability of hydrometeorological hazards including their evolution within the next century. One of the most important results of the program will be its observational campaigns, which will greatly improve the data available, leading to significant scientific results. The interest of the program for the Spanish research groups is described, as the active participation of some of them in the design and execution of the observational activities. At the same time, due to its location, Spain is key to the program, being a good observation platform. HyMeX will enrich the work of the Spanish research groups, it will improve the predictive ability of the weather services, will help us to have a better understanding of the impacts of hydrometeorological extremes on our society and will lead to better strategies for adapting to climate change.

Servicios avanzados de seguridad para un sistema de emergencias

La recuperación de un desastre requiere la coordinación e interacción oportuna de todos los servicios de emergencias para poder hacer una valoración conjunta de los datos obtenidos y elaborar una respuesta rápida y efectiva. En el presente trabajo se propone un sistema que permite el acceso, manipulación y transferencia de información sensible y urgente entre el personal de los organismos implicados. Los privilegios sobre los recursos están regulados mediante políticas de seguridad que permiten definir el comportamiento del servicio en función de la sesión o contexto temporal del solicitante. La arquitectura propuesta está basada en tecnología de redes ad hoc para el campo de operaciones, y una plataforma orientadaa servicios en las sedes corporativas.