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Biomedical subjects

J J García García

Publications and source records attributed to J J García García.

16 recordsLinked to original sources
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

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

[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↗
PubMed1998

Effect of polar glycopeptidolipids from Mycobacterium chelonae (GPLp-Mc) on phagocytosis and superoxide anion production of macrophages from mice. Influence of physical activity.

It is not clear how macrophages respond to exercise when the immune system is previously activated. The aim of the present work was to determine the response of macrophages to exercise in already immunostimulated animals with polar glycopeptidolipids extracted from Mycobacterium chelonae (GPLp-Mc). Results showed an increased phagocytosis and O2- production in murine macrophages induced by the intraperitoneal administration of 25 mg/kg body weight of GPLp-Mc. In addition exercise stimulated phagocytic activity and decreased the O2- production of these cells. Unexpectedly, exercise did not potentiate the immunostimulatory effect of GPLp-Mc. However, we can conclude that the effect of exercise is not detrimental to immunostimulated animals.

Adjuvants, Immunologic↗
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↗
PubMed1996

[A new method for evaluating psychomotor development based on information from parents. The Spanish version of the Kent Infant Development Scale].

OBJECTIVE: The purpose of this dissertation research was to design, standardize and validate the Spanish version of the Kent Infant Development Scale (KIDS). PATIENTS AND METHODS: This questionnaire is based on information obtained from the parents. It was translated into Spanish and named "Escala de Desarrollo Infantil de Kent" (EDIK). The EDIK normative data were collected from the parents of 662 healthy infants (ages 1 to 15 months) in pediatric clinics in Catalonia (Spain). RESULTS: Test-retest reliability (r = 0.99; p < 0.001), interjudge reliability (r = 0.98; p < 0.001) and internal consistency (Cronbach alpha = 0.9947) were determined. An "r' of 0.96 was obtained when EDIK scores were compared to their estimated developmental ages obtained from the Denver Developmental Scale. The correlation of the infants' chronological age and their EDIK was 0.96 (p < 0.001). CONCLUSIONS: The high reliability and validity correlation coefficients demonstrate the sound psychometric properties of the EDIK. It appears to be a useful and acceptable instrument in measuring the developmental status of infants by using the reports of their parents.

Adult↗
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↗