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C Luaces Cubells

Publications and source records attributed to C Luaces Cubells.

25 records · Page 2Linked to original sources
PubMed1997

Clinical data in children with meningococcal meningitis in a Spanish hospital.

Neisseria meningitidis is the main cause of bacterial meningitis in Spain. Of the 213 children included in this study with meningococcal meningitis, 7 died. Mortality was linked to a shorter time from the first symptom to diagnosis (mean time for fatal cases was 9.5 h, mean time for survivors was 19 h, p = 0.034), to deteriorated consciousness (DC) (mortality rate (MR) with DC = 6/87, MR without DC = 1/124, p = 0.02) and to shock (MR with shock = 5/7, MR without shock = 2/206, p < 0.0001). Previous treatment reduced the yield from blood culture (36/54 versus 45/137, p < 0.0001). Positivity in both Gram stain (GS) and cerebrospinal fluid (CSF) culture increased with longer duration of symptoms (mean GS+ = 25 h, GS- = 16 h, p = 0.004; CSF+ = 20 h, CSF- = 12 h, p = 0.001), and blood culture (BC) gave more positive results when carried out earlier (mean BC- = 14 h, BC- = 24 h, p < 0.001). Reduced susceptibility to penicillin was seen in 34% of the strains, and rapidly evolving forms were responsible for most of the deaths; reduced susceptibility was more frequent among strains responsible for death or sequelae (9/15 = 60%) as compared with the more harmless strains (69/ 215 = 32%) (p = 0.04). The progressive reduction of susceptibility to penicillin indicates that it should be replaced by a third-generation cephalosporine.

Adolescent↗
PubMed1997

[Routes of endotracheal colonization in patients with mechanical ventilation].

OBJECTIVE: We prospectively evaluated the frequency and route of endotracheal colonization in intubated children in order to know what microorganisms, either by primary infection or through previous colonization of oropharynx and/or stomach and progression towards the lower respiratory tract, are responsible for these infections. PATIENTS AND METHODS: Oropharyngeal, tracheal and gastric samples of 43 patients were collected for culture at the moment of intubation and at 24-h intervals for 4 days. The colonization route for each endotracheal microorganism was classified depending on the initial isolation site. Isolated microorganisms were considered as belonging to the same strain if the biochemical pattern and antibiogram were identical. RESULTS: Of the patients studied, 84% presented positive cultures the first day. Tracheal colonization was detected at day 1 in 22 patients (51%) and in 35 (82%) at the end of the study. A colonization sequence was seen in 18 patients (41%). The microorganisms most frequently isolated were S. aureus, P. aeuruginosa and C. albicans. CONCLUSIONS: The mechanisms of tracheal colonization in intubated children is similar to adults. Oropharynx colonization is the key antecedent. Prophylaxis measures should avoid the proliferation at the oropharyngeal and/or gastric level.

Adolescent↗
PubMed1997

[Epidural hematoma in children. Prognostic factors. Analysis of 70 cases].

OBJECTIVE: The aim of this study was to analyze the causes of epidural hematoma in order to know its incidence in craneoencephalic trauma and establish prognostic criteria. PATIENTS AND METHODS: A retrospective study of 70 children with the diagnosis of epidural hematoma between 1990 and 1995 were studied. Clinical, radiological, chronologic variables and evolution were analyzed. RESULTS: The diagnosis was made during the first 4 years in 63% of the cases. Neurologic impairment was present at admission in only 33% of the patients. Ages ranged between 7 days and 17 years (mean age: 8 years). Of these patients, 82% were admitted to the PICU, 53% were ventilated and 19% needed ICP monitorization. Radiological findings on the first CT were skull fracture (68%) and temporoparietal epidural hematoma (66%), right-sided (63%). Other kinds of lesions were also recorded in the first and subsequent CTs. Three patients died, 63% recovered fully, 10% had serious sequelae and 23% had some degree of neurodisability. CONCLUSIONS: The following data correlated with death or neurological impairment: Multiple cerebral contusion (p = 0.002), brain edema (p = 0.05), GCS less than 8 on admission (p = 0.002), and shock (p = 0.003). On the other hand, neither surgical drainage volume, age, location of the hematoma, nor ICP values correlated with a poor prognosis.

Child↗
PubMed1996

[The usefulness of a clinical scoring system and pulse oximetry (SaO2) in assessing the severity of asthmatic crises].

OBJECTIVE: To evaluate the ability of the Wood-Downes modified score (SPC) and the pulse oximetry to identify children with acute asthma who need hospitalization. PATIENTS AND METHODS: One hundred twenty-one children were evaluated before (SPC-1, SaO2-1) and after (SPC-2, SaO2-2) nebulized salbutamol. RESULTS: Nebulization with salbutamol improved both SPC and SaO2 (p < 0.001). A correlation was found between SPC-1 and SaO2-1 (r = -0.44, p < 0.001). The admitted patients differed significantly from the discharged ones in all four variables analyzed. No statistically significant difference was found to predict admission when a receiver operating characteristic curve was done between SPC-1 and SaO2-1. On the other hand, SPC-2 values predicted admission better than SaO2-2 (p < 0.0001). The cut-off points were considered to be: SPC-1 > or = 4; SaO2-1 < or = 91; SPC-2 > or = 2; and SaO2-2 < or = 96, with sensitivities of 60%, 47%, 100% and 47% and specificities of 76%, 92%, 69% and 84%, respectively. CONCLUSIONS: 1. Both pulse oximetry and clinical SPC improved after treatment. 2. All four variables analyzed predict the need for hospitalization with no differences between SPC-1 and SaO2-1, with SPC-2 being better in predicting admission than SaO2-2.3. Pulse oximetry is an objective method, complementary to clinical judgement in deciding whether to hospitalize.

Adolescent↗