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C Luaces Cubells

Publications and source records attributed to C Luaces Cubells.

At least 19 recordsLinked to original sources
PubMed2006

[Neonatal management in the emergency department of a tertiary children's hospital].

OBJECTIVE: To determinate the chief complaints in neonates presenting to a pediatric emergency service and their management. MATERIAL AND METHODS: We performed a retrospective study of patients younger than 28 days old who presented to the pediatric emergency department in 2003. Patients directly admitted to the neonatal unit and those attended by the surgery and orthopedic surgery departments were excluded. Information on sex, age, time and date, waiting time, visit duration, source of referral, presenting complaint, complementary examinations, final diagnosis, and hospital admission were analyzed. RESULTS: There were 1,481 neonatal visits. The mean chronological age was 15.8 days and 57.3 % were boys. Visits were most frequent on Fridays, evening shifts, and in July and December. The most frequent chief complaints were crying/irritability (16.3 %), fever (13.6 %), vomiting (11 %), and influenza (10.8 %). The most frequent final diagnoses were feeding problems (12.6 %), infantile colic (12.4 %), and upper respiratory tract infections (12 %). No abnormalities were detected in 11.7 % of the patients and complementary examinations were not required in 45.9 %. The admission rate was 26 %, most commonly due to fever and bronchiolitis. CONCLUSIONS: Many visits were due to minor problems that did not require complementary examinations and could have been resolved in primary care. Because of the greater vulnerability of this age group, thorough investigation is required to rule out severe disease. This phenomenon was reflected by the large number of complementary examinations and admissions.

Emergency Service, Hospital↗
PubMed2005

[Doxycycline-induced esophagitis: report of two cases].

Drug-induced esophagitis has frequently been reported in adults, with more than 100 substances involved. However, only a few cases occurring in the pediatric population have been published. The most frequently involved drugs are antibiotics and the incidence of esophagitis is thought to be greater than estimated due to the increase in antibiotic prescription in the last few decades. A medical history suggestive of retrosternal pain, odynophagia with or without dysphagia, and recent drug intake are suspicious for this entity. Although most cases are self-limiting, complications such as hemorrhage or perforation have been described. We present two cases of doxycycline-induced esophagitis in two teenagers that illustrate the clinical course, endoscopic pattern and treatment of this entity.

Adolescent↗
PubMed2004

[Postvaricella purpura fulminans].

Purpura fulminans (PF) is an infrequent complication of varicella characterized by the progressive development of purpuric or painful ecchymotic lesions associated with biochemical alternations typical of consumption coagulopathy. Activation of coagulation is due to a marked and prolonged decrease in protein S, which is probably secondary to the formation of antiprotein S antibodies. The mechanism responsible for the synthesis of these autoantibodies is unknown. We present three cases of postvaricella PF and review the clinical and biochemical characteristics of this entity, as well as current diagnostic and therapeutic recommendations.

Antibodies↗
PubMed2003

[Idiopathic palatopharyngeal hemiparalysis].

Idiopathic velopalatine palsy is a condition of unknown etiology and is rarely seen in childhood. Consequently, diagnosis requires a high degree of suspicion. We report a case of sudden onset dysfunction of the lower cranial pairs (IX and X) in a 5-year-old girl who was previously asymptomatic. The clinical course was favorable and the results of complementary investigations were normal and the patient was diagnosed with velopalatine palsy. Based on this case, we aim to report our experience of this condition and provide a review of the literature. This disease should be suspected in patients aged between 5 and 15 years old who present a palsy of the IX and X cranial nerves of sudden onset and without any other symptoms in order to rationalize diagnostic and therapeutic tools. Treatment is based on support measures. The prognosis is excellent, with a high percentage of complete recovery and absence of recurrences.

Child, Preschool↗
PubMed2003

Procalcitonin in pediatric emergency departments for the early diagnosis of invasive bacterial infections in febrile infants: results of a multicenter study and utility of a rapid qualitative test for this marker.

BACKGROUND: Procalcitonin (PCT) is a potentially useful marker in pediatric Emergency Departments (ED). The basic objectives of this study were to assess the diagnostic performance of PCT for distinguishing between viral and bacterial infections and for the early detection of invasive bacterial infections in febrile children between 1 and 36 months old comparing it with C-reactive protein (CRP) and to evaluate the utility of a qualitative rapid test for PCT in ED. METHODS: Prospective, observational and multicenter study that included 445 children who were treated for fever in pediatric ED. Quantitative and qualitative plasma values of PCT and CRP were correlated with the final diagnosis. To obtain the qualitative level of PCT the BRAHMS PCT-Q rapid test was used. RESULTS: Mean PCT and CRP values in viral infections were 0.26 ng/ml and 15.5 mg/l, respectively. The area under the curve obtained for PCT in distinguishing between viral and bacterial infections was 0.82 (sensitivity, 65.5%; specificity, 94.3%; optimum cutoff, 0.53 ng/ml), whereas for CRP it was 0.78 (sensitivity, 63.5%; specificity, 84.2%; optimum cutoff, 27.5 mg/l). PCT and CRP values in invasive infections (PCT, 24.3 ng/ml; CRP 96.5 mg/l) were significantly higher than those for noninvasive infections (PCT, 0.32 ng/ml; CRP, 23.4 mg/l). The area under the curve for PCT was 0.95 (sensitivity, 91.3%; specificity, 93.5%; optimum cutoff, 0.59 ng/ml), significantly higher (P < 0.001) than that obtained for CRP (0.81). The optimum cutoff value for CRP was >27.5 mg/l with sensitivity and specificity of 78 and 75%, respectively. In infants in whom the evolution of fever was <12 h (n = 104), the diagnostic performance of PCT was also greater than that of CRP (area under the curve, 0.93 for PCT and 0.69 for CRP; P < 0.001). A good correlation between the quantitative values for PCT and the PCT-Q test was obtained in 87% of cases (kappa index, 0.8). The sensitivity of the PCT-Q test (cutoff >0.5 ng/ml) for detecting invasive infections and differentiating them from noninvasive infections was 90.6%, with a specificity of 83.6%. CONCLUSIONS: PCT offers better specificity than CRP for differentiating between the viral and bacterial etiology of the fever with similar sensitivity. PCT offers better sensibility and specificity than CRP to differentiate between invasive and noninvasive infection. PCT is confirmed as an excellent marker in detecting invasive infections in ED and can even make early detection possible of invasive infections if the evolution of the fever is <12 h. The PCT-Q test has a good correlation with the quantitative values of the marker.

Bacteremia↗
PubMed2003

[Somatization symptoms. An emerging pediatric entity].

BACKGROUND: Somatization symptoms are a clinical reality in our environment. However, many pediatricians have little information about this condition or experience of its management. OBJECTIVE: To determine the clinical and differential characteristics of these patients. The early identification of these patients and initiation of therapy in the initial stages of the process would improve prognosis. MATERIAL AND METHOD: A retrospective review was performed of the children admitted to the short-stay unit of a tertiary hospital because of somatic complaints and whose final diagnosis was that of a somatization disorder. RESULTS: Sixty medical records were analyzed, of which 38 (63 %) corresponded to girls, with a mean age of 11 years at presentation. The most frequent reasons for consultation were related to the digestive and neurological systems. Thirty-four patients (57 %) had previously consulted for the same reason. In the sample analyzed, the most frequent personality trait was anxiety. The main triggers were familial and school factors. The most frequent diagnosis was pain disorder in 42 children (70 %). All patients received psychotherapy and 39 received complementary pharmacological treatment. CONCLUSIONS: The data analyzed in this study indicate that somatization symptoms most frequently occur in anxious, prepubescent girls, with migraine or non-specific abdominal pain of approximately one month's duration. Patients have usually made several previous visits and no organic causes are discovered on physical examination.

Adolescent↗
PubMed2001

[Triage criteria in a emergency department].

OBJECTIVE: Accurate patient triage for the early identification of potentially seriously ill or high-risk children is needed due to the increasing demands made on paediatric emergency departments. MATERIAL AND METHODS: A set of triage criteria for patient selection was established. Between October 1998 and April 1999 we selected 20 days with maximum patient flow in our emergency department (average 225 children/day). Patients who satisfied the triage criteria were selected. The following variables were studied: age, sex, triage criteria, waiting time, visit time and final diagnosis. RESULTS: Five hundred and thirteen patients satisfied our triage criteria (11% of patients admitted to the emergency department). Median age was 3.4 years. The most frequent complaints (criteria) were dyspnea (36.4%), referral to the emergency department by another physician (29%), fever and rash (11.7%) and age under 1 month (5.8%). The most common causes of patient referral to hospital were acute abdominal pain and fever (31% each). Waiting and visit times were 29 and 55 minutes, respectively. CONCLUSION: Definition of selection criteria seems effective and equivalent to other triage systems and allows optimization of human resources.

Adolescent↗
PubMed2001

[Causes of adolescent visits to the emergency department].

OBJECTIVE: To determine the complaints leading adolescents to a third level emergency department, as well as the distinguishing features between the different groups of complaints. MATERIAL AND METHODS: Retrospective study of the emergency department reports of 170 adolescents selected from the 1,172 adolescents who visited the Hospital Sant Joan de Déu pediatric emergency department in May 1997. We excluded 517 patients with trauma. Statistical analysis was carried out with the chi-square test for qualitative variables and analysis of variance for quantitative variables; differences were accepted as significant at p,0.05. RESULTS: Eighty-nine patients were female and 81 were male. Median age was 13.8 years. The most frequent discharge diagnoses were abdomen pain in 26 patients, viral illness in 15 and depression-anxiety in 14. Complementary investigations were carried out in 60 patients. One hundred forty-one patients were discharged. Of the 26 patients with psychiatric disorders, 18 were girls and 8 were boys. The proportion of girls was also higher among patients with abdominal and neurological symptoms, although not among patients with organic disorders (p50.03). Most of the patients with psychiatric antecedents were diagnosed with a psychiatric disorder. Ten (11.8%) of the 85 patients with organic complaints were admitted to hospital compared with 13(50%) of the 26 patients with psychiatric disorders (p,0.001). CONCLUSIONS: Adolescents visit emergency departments for a variety of complains. The proportion of psychiatric disorders and non-specific symptoms is high.

Adolescent↗
PubMed2001

[Procalcitonin in the early diagnosis of invasive bacterial infection in febrile infants].

BACKGROUND: Procalcitonin (PCT) it is a new marker of bacterial infection. Because of its shorter half-life and earlier ascent it offers advantages over C-reactive protein (CRP). OBJECTIVE: To compare the diagnostic performance of PCT in the early detection of invasive bacterial infection in infants with that of CPR. MATERIAL AND METHODS: Between January of 1998 and February of 2000 we performed a prospective observational study in the emergency department of infants aged between 1 and 36 months who had been treated for fever and for whom PCT and CRP plasmatic values had been obtained. Plasmatic PCT and PCR values were evaluated and correlated with the final diagnosis. ROC curves for both markers were calculated. RESULTS: One hundred infants with a mean age of 8.8 months (SD 7.59) were included in four groups of 25 patients each (viral infection, localized bacterial infection, invasive bacterial infection and control group). The mean PCT and CRP values in invasive bacterial infections [PCT: 14.45 ng/mL (SD 27.95) and CRP: 95.10 mg/L (SD 7 2.77)] were significantly higher than in non-invasive infections [PCT: 0.27 ng/mL (SD 0.19) and CRP: 25.67 mg/L (SD 33.04)] but the diagnostic performance of PCT was better. The area under the curve for PCT was 0.95 (SD 0.03), which was significantly higher (p < 0.001) than that obtained for CRP [0.81 (SD 0.05)]. The optimal cut-off for PCT was > 0.4 ng/mL (sensitivity: 95.5 %; specificity: 86.4 %) and that for CRP was > 42.9 mg/L (sensitivity: 75 %; specificity: 81.8 %). In infants who had fever for less than 12 hours (n 30) the area under the curve for PCT was 0.90 (SD 0.06), which was higher (p < 0.001) than that for PCR [0.64 (SD 0.11)]. The optimal cut-off for PCT in this group was > 0.4 ng/mL (sensitivity: 90 %; specificity: 94 %) and that for CRP was > 26.6 mg/L (sensitivity: 60 %; specificity: 77.8 %). CONCLUSIONS: The diagnostic performance of PCT was higher than that of CRP in the early detection of invasive infection in febrile infants, even when evolution was less than 12 hours.

Bacterial Infections↗
PubMed2000

[Voluntary poisoning as a form of attempted suicide].

BACKGROUND: Voluntary intoxication as form of attempted suicide is currently a significant problem among the teenage population. Suicide attempt is the most frequent psychiatric emergency in adolescents. We present our 2-year experience of voluntary intoxication in a pediatric population. MATERIALS AND METHODS: Retrospective and descriptive study of patients admitted because of voluntary intoxication in our center from January 1996 to December 1997. We analyzed age, sex, approximate time of intoxication, toxic habit antecedents, psychiatric evaluations or previous intoxications, type of toxic substance and method of obtaining it, symptomatology on arrival at the emergency department, therapeutic attitude and most common complementary examinations, and days of hospital stay. RESULTS: Forty-six patients with voluntary intoxication were admitted during the study period. The mean age was 15.6 years; 40 patients (87%) were female. Twenty-eight patients (60.9%) had previously been evaluated in a psychiatric department. The toxic substance used was of pharmacological origin, and in 38 patients (82.6%) it was obtained from the home first-aid kit. In 22 patients (47.8%) intoxication was due to multiple drugs. Six patients (13%) required admission to the pediatric intensive care unit. Mean duration of admission was 3 days. COMMENTS: Voluntary intoxication as a form of attempted suicide is a significant problem among the teenage population, especially among teenage girls. The best preventive measure would be identification of the at-risk population, which consists mainly of teenage girls with depression, eating disorders, or previous suicide attempts.

Adolescent↗
PubMed1999

[Headache in a short-stay unit. A retrospective study of 140 cases].

OBJECTIVE: Our objective was to study those patients that warranted admission to our Short-Stay Unit (Observation Unit) with an incoming diagnosis of headache so as to determine the characteristics of the headache, analyze complementary explorations and their use and to establish the causes of the problem. PATIENTS AND METHODS: A retrospective review of the clinical history of patients admitted for headache between 1992 and 1997 was done, recording specific data according to pre-set objectives. RESULTS: One hundred forty patients were admitted with headache (2% of total admittance to the Unit. Sixty-one percent were males. Seventy cases were between 11 and 15 years old. The most frequent accompanying symptoms were vomiting (61%), fever (31%) and various concurrent infections (21%). Seventy-two cases (51%) presented an evolution of less than 24 hours before admittance. Frontal headache was the most common localization, 30.6% of the patients were awaken by the pain and 32% calmed with analgesics. CAT scan/70%) and skull X-ray (59%) were the most used complementary explorations. Ten CAT scans and 3 X-rays showed anomalies. Evolution was favorable in most cases. The most frequent diagnoses were headache associated with infections (31%), tension headaches (29%) and migraine (21%). Fourteen percent were non-specific headaches. A central nervous system tumor was diagnosed in 6 patients, where 5 showed papilledema on initial exploration. CONCLUSIONS: Headache, especially in adolescents, is a common cause of consultations to the emergency room. When not accompanied by other symptoms it is not usually precluding a severe disease. In an emergency room exploration, a complete neurological exam must be undergone, including retinal exam, leaving further complementary exams for those cases where the patient history suggests an organic alteration.

Adolescent↗
PubMed1998

[Complications of cerebrospinal fluid shunt].

OBJECTIVE: The objective of this study was to know the incidence, mode of presentation, clinical and microbiological aspects, as well as the management of ventriculo-peritoneal shunt malfunction. PATIENTS AND METHODS: A retrospective study was carried out where thirty-seven children with malfunctioning shunts were studied. The mechanical causes of shunt malfunction included disconnection, fracture and obstruction, while infection was considered as either a clinical or analytical change (blood and/or CSF). RESULTS: The mean age of the patients was 5.5 years. The most common indication for the insertion of the ventriculoperitoneal shunt was congenital hydrocephalus. The average stay in the ICU was 8.2 days. Mechanical dysfunction was detected in 25 patients (68%) and infectious etiology in 12. The most common clinical manifestations were vomiting, fever and headache. CSF biochemical alteration was found in 8 of the infected group. Staphylococcus was isolated in six of the 8 cases. The ventriculoperitoneal shunt was changed during the first 24 hours in 17 of 25 patients (68%) with mechanical malfunction, while 11 cases with an infective cause (92%) were managed with an external shunt. The interval between the insertion of the ventriculoperitoneal shunt and the malfunction was over 6 months in 20 cases (54%). CONCLUSIONS: Ventriculoperitoneal shunts are the main method for treating hydrocephaly, although they are not without complications which may require surgical procedures. Appropriate surgical technique, asepsis, as well as prophylactic antibiotics are essential to decrease the incidence of complications.

Cerebrospinal Fluid Shunts↗