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J Casado Flores

Publications and source records attributed to J Casado Flores.

At least 19 recordsLinked to original sources
PubMed2006

[Factors associated with the prognosis of mechanically ventilated infants and children. An international study].

OBJECTIVE: Identify factors associated with the survival of pediatric patients who are submitted to mechanical ventilation (MV) for more than 12 hours. DESIGN: International prospective cohort study. It was performed between April 1 and May 31 1999. All patients were followed-up during 28 days or discharge to pediatric intensive care unit (PICU). SETTING: 36 PICUs from 7 countries. PATIENTS: A total of 659 ventilated patients were enrolled but 15 patients were excluded because their vital status was unknown on discharge. RESULTS: Overall in-UCIP mortality rate was 15,6%. Recursive partitioning and logistic regression were used and an outcome model was constructed. The variables significantly associated with mortality were: peak inspiratory pressure (PIP), acute renal failure (ARF), PRISM score and severe hypoxemia (PaO2/FiO2 < 100). The subgroup with best outcome (mortality 7%) included patients who were ventilated with a PIP < 35 cmH2O, without ARF, or PaO2/FiO2 > 100 and PRISM < 27. In patients with a mean PaO2/FiO2 < 100 during MV mortality increased to 26% (OR: 4.4; 95% CI 2.0 to 9.4). Patients with a PRISM score > 27 on admission to PICU had a mortality of 43% (OR: 9.6; 95% CI 4,2 to 25,8). Development of acute renal failure was associated with a mortality of 50% (OR: 12.7; 95% CI 6.3 to 25.7). Finally, the worst outcome (mortality 58%) was for patients with a mean PIP >/= 35 cmH2O (OR 17.3; 95% CI 8.5 to 36.3). CONCLUSION: In a large cohort of mechanically ventilated pediatric patients we found that severity of illness at admission, high mean PIP, development of acute renal failure and severe hypoxemia over the course of MV were the factors associated with lower survival rate.

Adolescent↗
PubMed2004

What is the daily practice of mechanical ventilation in pediatric intensive care units? A multicenter study.

OBJECTIVE: To describe the daily practice of mechanical ventilation (MV), and secondarily, its outcome in pediatric intensive care units (PICUs). DESIGN: Prospective cohort of infants and children who received MV for at least 12 h. SETTING: Thirty-six medical surgical PICUs. PATIENTS: All consecutive patients admitted to the PICUs during 2-month period. MEASUREMENTS AND MAIN RESULTS: Of the 1893 patients admitted, 659 (35%) received MV for a median time of 4 days (25th percentile, 75%: 2, 6). Median of age was 13 months (25th percentile, 75%: 5, 48). Common indications for MV were acute respiratory failure (ARF) in 72% of the patients, altered mental status in 14% of the patients, and ARF on chronic pulmonary disease in 10% of the patients. Median length of stay in the PICUs was 8 days (25th percentile, 75%: 5, 13). Overall mortality rate in the PICUs was 15% (confidence interval 95%: 13-18) for the entire population, 50% (95% CI: 25-74) in patients who received MV because of acute respiratory distress syndrome, 24% (95% CI: 16-35) in patients who received MV for altered mental status and 16% (95% CI: 9-29) in patients who received MV for ARF on chronic pulmonary disease. CONCLUSION: One in every 3 patients admitted to the PICUs requires ventilatory support. The ARF was the most common reason for MV, and survival of unselected infants and children receiving MV for more than 12 h was 85%.

Child, Preschool↗
PubMed2004

[Meningococcal sepsis in pediatrics. Parameters associated with poor outcome].

BACKGROUND: Mortality due to meningococcal sepsis continues to be extremely high. Patients with a poor prognosis require aggressive therapy and should be identified early. OBJECTIVE: To investigate the clinical and biological factors associated with poor outcome. PATIENTS AND METHOD: Seventy-one children aged 2 months to 13 years with meningococcal sepsis were studied. Inclusion criteria were meningococcus isolation in cultures or characteristic clinical features with purpuric exanthema. METHODS: A correlational descriptive study was performed. In all patients we evaluated the Pediatric Risk of Mortality (PRISM), the Glasgow Scale for Meningococcal Sepsis (GSMS), polymorphonuclear (PMN) count and prolactin (PRL), leptin (LPT) and C-reactive protein (CRP) levels. RESULTS: Fourteen children (19.7 %) died. Death was associated with multiple organ dysfunction syndrome (MODS) (p = 0.0001), high GSMS and PRISM scores (p = 0.0001) and to a lesser extent with shock (p = 0.01). In patients who died, the determinations showing greatest alteration at admission were PRL levels (p = 0.0009) and PMN count (p = 0.0005). CRP levels were not associated with differences in mortality but were high in patients with shock (p = 0.008). Children with high body weight percentiles were at greater risk of death and showed higher levels of PRL, PCT (p = 0.006) and LPT (p = 0.006), without differences in GSMS or PRISM scores. Age did not influence mortality or PRL levels but did influence GMSM and PRISM scores and PMN and CRP levels. These differences disappeared after the age of 2-3 years. In patients with MODS or shock, the only differences found were reduced PMN count (p = 0.0001) and elevated PRL levels (p = 0.0001). CONCLUSIONS: In meningococcal sepsis, death is more frequent in children with high body weight percentiles. Moreover, these children present elevated PRL and LPT levels, although whether these variables act independently remains to be elucidated.

Adolescent↗
PubMed2002

[Prevalence pneumococcal meningitis in Spanish children].

OBJECTIVE: To determine the prevalence of pneumococcal meningitis in the pediatric population in Spain. Material and methods Retrospective multicenter study performed in five autonomous communities (Catalonia, Galicia, Madrid, Navarre and the Basque Country) between January 1998 and December 2000. All patients aged between 0 and 14 years old with a diagnosis of pneumococcal meningitis (Streptococcus pneumoniae isolation or presence of Gram-positive diplococcus in the cerebrospinal fluid (CSF) and CSF with more than 20 cells) in all the hospitals of the five autonomous communities were included in the study. The pediatric population in these communities aged between 0 and 14 years old was 2,327,079. RESULTS: We detected 107 cases in 64 boys and 43 girls with a mean age of 1.19 years old (p 25-0.57; p 75-3.34). The incidence was higher in the first 2 years of life [72/107 (67 %)]. The overall annual prevalence in the five autonomous communities in the first 24 months of life was 8.26 per 100,000 children aged under 2 years (95 % CI: 3.45-15.76). The highest number of cases was detected in Catalonia and Madrid but the highest annual prevalence was found in the Basque Country with 15.52 cases per 100,000 children younger than 2 years old (95 % CI: 8.38-24.74). In the first 12 months of life the prevalence was high in all the autonomous communities, especially in the Basque Country with 22.76 cases per 100,000 newborn infants aged under 12 months (95 % CI 14.58-34.5). In the first 5 years of life the annual global adjusted prevalence per 100,000 children was as follows: Catalonia 3.21 (95 % CI: 1.31-5.11), Galicia 2.65 (95 % CI: 0.35-5.64), Madrid 3.49 (95 % CI: 1.36-5.61), Navarre 3.36 (95 % CI 5,08-11,81), the Basque Country 5.63 (95 % CI: 1.08-10.18). CONCLUSION: The prevalence of pneumococcal meningitis in children from different autonomous communities is high and is greatest in the Basque Country and in children aged under 2 years. This prevalence is similar to that of other European countries and the USA.

Adolescent↗
PubMed2002

[Pneumococcal meningitis in Spanish children: incidence, serotypes and antibiotic resistance. Prospective and multicentre study].

OBJECTIVE: To determine the incidence, as well as the implicated serotypes and patterns of antibiotic resistance of Streptococcus pneumoniae meningitis in Spanish children. MATERIAL AND METHOD: We performed a prospective, multicenter study in five Autonomous Communities (Catalonia, Galicia, Madrid, Navarre and the Basque Country) for 1 year (1 February 2000 31 January 2001). All children aged 0-14 years with pneumococcal meningitis from all the hospitals in the Autonomous Communities studied were included. Diagnosis was based on clinical findings and isolation of S. pneumoniae in the cerebrospinal fluid/blood using routine methods or polymerase chain reaction. Serotyping was performed using the guellung reaction and/or immunoblotting and susceptibility to antibiotics was evaluated by the technique of agar dilution. The pediatric population aged 0-14 years in the Autonomous Communities studied comprises 2,290,304 children. RESULTS: Fifty-two cases were identified. One patient was aged less than 2 months old, 25 (48 %) were aged 2-12 months, and 12 patients (23 %) were aged 12-24 months. The annual incidence per 100,000 children aged between 1 and 2 years was 17.75 cases (95 % CI: 11.59 26.01) and 8.39 cases (95 % CI: 4.67 15.79) respectively, and that for children in the first 2 and 5 years of life was 13.13 (95 % CI: 9.29 18.02) and 6.29 (95 % CI: 4.57 8.,45) cases respectively. Nearly half the strains isolated (47.6 %) showed reduced sensitivity to penicillin. The most frequent serotype was 19F (12 cases [28.6 %]). Eighty percent of the isolated serotypes were included in the formula of the heptavalent conjugate vaccine. CONCLUSIONS: The incidence of pneumococcal meningitis in children from five Spanish Autonomous Communities is high, nearly twice that found in a prior retrospective studied performed in the same population 1-3 years previously. Almost all the isolated serotypes were included in the heptavalent conjugate vaccine. Half the strains showed reduced sensitivity to penicillin.

Adolescent↗
PubMed2001

[Procalcitonin. A new marker for bacterial infection].

Procalcitonin is a polypeptide present in the plasma of healthy subjects in minimal levels (< 0.5 ng/ml). Serum procalcitonin is markedly increased a few hours after the administration of endotoxin to human volunteers and in invasive bacterial infection (sepsis, septic shock, meningitis). Procalcitonin is moderately increased in local bacterial infection (pneumonia pyelonephritis) and is unchanged in viral infections or bacterial colonization. Procalcitonin is increased in serious bacterial infections in neonates, children and adults and is currently the best diagnostic marker of severe bacterial infection, being better than leukocyte, interleukin or C-reactive protein counts. C-reactive protein levels can be normal in severe sepsis and some viral infections. We studied 54 children with sepsis in whom plasma procalcitonin levels showed a positive correlation with the vasoactive drugs necessary to maintain cardiovascular activity. The semiquantitative procalcitonin test is simple and easy to use at the bedside at any time and in any hospital as no instruments are required. Within 30 minutes, the test identifies the type of infection and whether antibiotics are indicated.

Adult↗
PubMed2001

[Gastric tonometry as monitoring system in abdominal surgery].

OBJECTIVE: The aim of this study is the evolution of the intramucosal pH (pHi) during the quirurgic and the immediate postoperative process in pediatric patients, operated in abdominal surgery longer than 90 minutes. MATERIAL AND METHODS: A prospective study including 25 patients was done. In all of them intraabdominal surgery was performed. The mean age was 5.6 +/- 3 years, range from 9 months to 13 years. The operative time was 207 +/- 76 minutes. The pHi was measured by means of a sigmoid tonometer introduced in the stomach. A tonometry was done hourly during the operative procedure, and every 8 hours during the postoperative period. RESULTS: 157 determinations of pHi were made with an average of 6.28 per patient. During the operative period the pHi decreased from 7.36 +/- 0.11 (30') to 7.22 +/- 0.11 (210'). During the postoperative, the pHi increased to 7.36 +/- 0.05, 24 hours later (p < 0.005). CONCLUSIONS: During the surgery there was a significant reduction of the pHi, which recovered 16 hours after in the postoperative.

Abdomen↗
PubMed2000

[Suicide in pediatric patients: 30 cases].

OBJECTIVE: The aim of this study was to evaluate suicide attempts in pediatric population and analyze the morbimortality. PATIENTS AND METHODS: We have reviewed thirty reports from twenty six patients hospitalized in UCIP by suicide attempts with an average age of 15.5 years (range 11-19) between January 1991 and April 1999. Results The following variables were analyzed: age, sex, precipitating suicidal event, number of suicide attempts, symptoms, method, treatment and mortality. The age group with more incidence was between 14 and 17 years with 73% (22 cases). The majority were girls (96%). There were prior suicide attempt in 40% (12 cases). Psychiatric disorder more frequently associated was anorexia nervosa in 70%. The most common method was self-poisoning (93%). Neurologic symptoms were seen in 20 cases. The more used treatment was activated coal. The clinical outcome was favourable and only two patients died. Conclusions The suicide attempts are happening more frequently in the adolescence in the last years. Pediatricians have to be prepared to recognize and provide prompt attention to acute medical, familiar and social problems.

Adolescent↗
PubMed2000

[Toxic shock syndrome in children. Report of four cases].

We report four children with toxic shock syndrome admitted in the pediatric intensive care unit of our hospital during the past year. All the children had the five criteria established by the Centers for Disease Control for the diagnosis of this syndrome. In all four there was a probable point of entry of the infection: maxillar sinusitis in one, pneumonia in two and surgical wound in the other. No bacteria that could have caused the infection were isolated in any of the children, which suggests a staphylococcal origin for this syndrome. Evolution was good in all of the children due to aggressive treatment that included inotropic support, volemic expansion and antibiotics. Two of the children, who suffered adult respiratory distress syndrome, required prolonged respiratory support.

Child↗
PubMed2000

[Abused children. Role of the pediatrician].

Child maltreatment, in it's different forms (physical, negligence, Münchausen syndrome by proxy, sexual abuses.), represents an important morbidity cause, especially in the first years of the life. Nowadays, the battered child syndrome includes forms of abuse and different degrees of negligence (moderate, serious and light) in which the physical abuse could be absent. Determination of the forms of abuse, their diagnosis, intervention and prevention, corresponds to multidisciplinary teams, in which the pediatrician has a crucial role.

Child↗
PubMed2000

[Pneumococcal meningitis in children. Review of 28 cases].

OBJECTIVE: To describe the epidemiological characteristics, clinical features and prognostic indicators of pneumococcal meningitis in children admitted to a children's hospital in Madrid. PATIENTS AND METHODS: We retrospectively studied 28 children with a diagnosis of pneumococcal meningitis based on identification of S. pneumoniae in the blood or cerebrospinal fluid between 1990 and 1999. None of the children had previous immunological deficit or had received antipneumococcal vaccine. RESULTS: The mean age of patients was 2.7 +/- 2.9 years (range 2 months to 11 years). Eighty-two percent of the children were younger than 5 years old. Male to female ratio was 1:1. The most frequent signs on admission were fever (100%), vomiting (57%), headache and irritability (53%), and shock (10%). Neurologic findings were lowered level of consciousness in 22 patients (man Glasgow Coma Scale score 9.9 +/- 3.9): seizures in 15 (53%); neck stiffness in 12 patients (42%) and arreactive mydriasis in 9 patients (32%). Twenty patients (71%) required admission to the intensive care unit. On discharge 15 patients (53%) had no sequelae; 8 patients (28%) suffered deafness; 4 (14%) had hemiparesis; 2 (7%) had severe hydrocephalus and 1 patient (3.5%) had mental retardation. Four patients (14%) died. Findings with the strongest predictive value for death or deafness (p > 0.05) were coma and alterations in cranial computer tomography (CT). Seizures, alterations in electroencephalogram (EEG) and hypoglycorrhachia were also prognostic indicators for deafness (p < 0.05). CONCLUSIONS: Meningitis caused by S. pneumoniae is a significant cause of morbidity and mortality in children. Deafness is one of the most common and serious sequelae of pneumococcal meningitis. Sequelae were associated with coma, alterations in CT scan, seizures and hypoglycorrhachia. The new, antipneumococcal conjugated vaccine will confer effective prevention from the age of 2 months and will produce a dramatic decrease in the incidence of this serious infection.

Anti-Bacterial Agents↗
PubMed1999

[Uremic hemolytic syndrome. Analysis of 43 cases].

OBJECTIVE: The purpose of this study was to describe the epidemiological, clinical and evolution features of hemolytic uremic syndrome (HUS). PATIENTS AND METHODS: A retrospective study of 43 cases of HUS during the last 14 years (1984-1998) was performed. RESULTS: The mean age of the patients was 3.2 years, the incidence during the summer season was the highest and 39 cases (90%) previously had acute gastroenteritis. All children had acute renal failure, 32 of them (74%) required peritoneal dialysis. Anuria was found in 22 case (51%) and the mean duration was 10.3 days. The most frequent complications were: Hypertension in 21 cases (48%), peritonitis in 9 cases (20%), seizures in 8 patients (16%) and 3 deaths (6%). The mean hospital stay was 14.5 days. After one year of ambulatory control, 76% of the children were completely recovered and only two cases (6%) had chronic renal failure. Seizures associated significantly with a bad prognosis (p < 0.05). CONCLUSIONS: HUS has a very important morbimortality. Seizures in the acute phase were associated with a bad prognosis. Anuria for more than 7 days and oliguria for more than 15 days were also predictors of a worse prognosis, but this was not significant.

Acute Kidney Injury↗