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Delgado-Miguel C, Muñoz-Serrano AJ, Moratilla L, Miguel-Ferrero M, Delgado B, Camps J, López-Santamaría M, Martínez L. Neutrophil-to-lymphocyte ratio as a predictor of surgical site infection in acute appendicitis. Transl Pediatr 2023; 12:552-559. [PMID: 37181027 PMCID: PMC10167395 DOI: 10.21037/tp-22-360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 02/26/2023] [Indexed: 05/16/2023] Open
Abstract
Background Surgical site infection (SSI) is one of the most common complications after appendectomy, which carries high associated morbidity. Therefore, it is essential to determine SSI predictive factors in order to prevent its occurrence. The aim of this study is to explore the role of neutrophil-to-lymphocyte ratio (NLR) as a predictor of SSI after appendectomy in children. Methods A single-center, retrospective cohort study was performed in children who underwent appendectomy between 2017-2020. Demographics, time since symptoms onset, laboratory tests at admission, ultrasound appendiceal diameter, rate of complicated appendicitis, surgical aproach, surgery time and SSI rate were analyzed. Follow-up was performed during hospitalization and at outpatient clinic at 2 weeks and 30 days postoperatively to assess the surgical wound aspect. Diagnostic cut-off values of these markers for SSI prediction were based on the significance in the univariate analysis. Variables with a P value <0.05 in the univariate analysis were then entered into the multivariate analysis. Results A total of 1,136 patients (710 males; 426 females) were included. SSI was reported in 53 patients (4.7%) during the 30-day follow-up after appendectomy (SSI group), with no demographic differences with the control group. Time since symptoms onset was significantly higher in SSI group (24 vs. 18 hours; P=0.034), as well as ultrasound appendiceal diameter (10.5 vs. 8.5 mm; P=0.010). Complicated appendicitis was observed in about 60% of both groups, without differences in surgical approach between them. Surgery time was statistically higher in the SSI group (62.4 vs. 47.9 min; P<0.001). SSI group presented higher counts of leukocytes, neutrophils and NLR than control group (P<0.001). NLR was the parameter with the highest area under the curve (AUC) (AUC =0.808; P<0.001), with a cut-off point of 9.8 with maximum sensitivity (77.8%) and specificity (72.7%). NLR was an independent predictive factor for SSI in the multivariate analysis [odds ratio (OR) 1.82 (1.13-2.73); P<0.01]. Conclusions NLR value at admission was the most promising predictive factor for the development of SSI in children undergoing appendectomy. It is an easy, simple, inexpensive, and rapid method to detect patients at high risk for SSI. However, further prospective studies are still needed to confirm these results.
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Affiliation(s)
- Carlos Delgado-Miguel
- Department of Pediatric Surgery, Prisma Health Children’s Hospital, Columbia, SC, USA
- Department of Pediatric Surgery, La Paz Children’s Hospital, Madrid, Spain
- Institute for Biomedical Resarch La Paz (IdiPaz), La Paz Children’s Hospital, Madrid, Spain
| | | | - Lucas Moratilla
- Department of Pediatric Surgery, La Paz Children’s Hospital, Madrid, Spain
| | | | - Bonifacio Delgado
- Department of Mathematics, Complutense University of Madrid, Madrid, Spain
| | - Juan Camps
- Department of Pediatric Surgery, Prisma Health Children’s Hospital, Columbia, SC, USA
| | | | - Leopoldo Martínez
- Department of Pediatric Surgery, La Paz Children’s Hospital, Madrid, Spain
- Institute for Biomedical Resarch La Paz (IdiPaz), La Paz Children’s Hospital, Madrid, Spain
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Delgado-Miguel C, Muñoz-Serrano AJ, Moratilla L, Sarmiento MDC, Miguel-Ferrero M, Martínez L. The effectiveness of matrix ablation with silver nitrate in the treatment of ingrown toenails. A single-center case-control study. Pediatr Dermatol 2022; 40:282-287. [PMID: 36461609 DOI: 10.1111/pde.15217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 11/14/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Partial onychectomy with chemical matrixectomy is considered the gold standard treatment for stage II-III ingrown toenails (IT). However, there are scarce reports describing the use of silver nitrate in IT management in adolescents. Our aim is to analyze the effectiveness of matrix ablation with silver nitrate and compare it with partial onychectomy by electrocautery. METHODS A retrospective study of adolescent patients with stage II-III IT was performed. Those who underwent electrocautery matricectomy in a major outpatient surgical center (Group A) and those who were treated with silver nitrate at an outpatient clinic (Group B) were compared. Efficacy was determined by recurrence and postoperative infection rates. RESULTS Two hundred and nine patients were included (86 group A; 123 group B), with a total of 382 partial onychectomies (151 group A; 231 group B). Group B patients exhibited a lower recurrence rate (4.7%) when compared to group A (11.2%, p = .02), and had a lower postoperative infection rate (4.0% group A vs. 1.7% group B; p = .18), although not statistically significant. CONCLUSION Silver nitrate chemical matricectomy after partial onychectomy is an effective treatment for IT in adolescents, with few postoperative complications and low recurrence rate. Therefore, it should be considered as a possible alternative to electrocautery matricectomy.
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Affiliation(s)
| | | | - Lucas Moratilla
- Pediatric Surgery Department, La Paz Children's Hospital, Madrid, Spain
| | | | | | - Leopoldo Martínez
- Pediatric Surgery Department, La Paz Children's Hospital, Madrid, Spain.,Institute for Biomedical Resarch La Paz (IdiPaz), Network for Maternal and Children Health (SAMID), La Paz Children's Hospital, Madrid, Spain
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Velayos M, Estefanía-Fernández K, Muñoz-Serrano AJ, Delgado-Miguel C, Sarmiento Caldas MC, Moratilla L, Beato Merino MJ, Triana P, López-Gutiérrez JC. Diffuse hepatocutaneous hemangiomatosis: an unusual presentation. Cir Pediatr 2022; 35:99-101. [PMID: 35485760 DOI: 10.54847/cp.2022.02.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Infantile hemangiomas with multi-organ involvement are rare, and presentation in the form of uncontrollable bleeding is exceptional. CLINICAL CASE 4-day-old newborn with multiple hepatocutaneous hemangiomas and a purplish vascular lesion in the third finger of the right hand. In the third week of life, the lesion became ulcerated and caused uncontrollable bleeding. Therefore, urgent amputation was required, with a histopathological result of GLUT-1 positive infantile hemangioma, and an architecture compatible with arteriovenous malformation in the deep portion. Imaging tests revealed it was a high-flow lesion. Genetic tests (MAP2KI, RASA 1, EPHB4, GNAQ, and GNA 11) were negative. Patient progression was good, with hepatocutaneous lesions receding and eventually disappearing. DISCUSSION No explanation has been given yet as to why the same vascular lesion may behave differently in different patients. New mutations may be accountable for this.
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Affiliation(s)
- M Velayos
- Pediatric Surgery Department. La Paz Pediatric Hospital. Madrid (Spain)
| | | | - A J Muñoz-Serrano
- Pediatric Surgery Department. La Paz Pediatric Hospital. Madrid (Spain)
| | - C Delgado-Miguel
- Pediatric Surgery Department. La Paz Pediatric Hospital. Madrid (Spain)
| | | | - L Moratilla
- Pediatric Surgery Department. La Paz Pediatric Hospital. Madrid (Spain)
| | - M J Beato Merino
- Pathological Anatomy Department. La Paz University Hospital. Madrid (Spain)
| | - P Triana
- Pediatric Surgery Department. La Paz Pediatric Hospital. Madrid (Spain)
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Delgado-Miguel C, Muñoz-Serrano A, Moratilla L, Sarmiento MDC, Miguel-Ferrero M, Leal N, Barrena S, Martínez L. Indocyanine Green (ICG)-Guided Identification of Hypermetabolic Pancreatic Nodules in Focal Congenital Hyperinsulinism: A Case Report in a 3-Month-Old Infant. European J Pediatr Surg Rep 2022; 10:e9-e12. [PMID: 35155078 PMCID: PMC8824696 DOI: 10.1055/s-0042-1742780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/23/2021] [Indexed: 11/07/2022] Open
Abstract
Indocyanine green (ICG)-guided near-infrared fluorescence has been recently adopted in pediatric surgery, although its use in the treatment of congenital hyperinsulinism has not been reported. We present a case of focal congenital hyperinsulinism in which ICG-navigation with ICG was used during surgical treatment. A 3-month-old infant was referred to our institution from a peripheral hospital for episodes of persistent hypoglycemia since birth, with no response to intravenous treatment with diazoxide, octreotide, or hydrochlorothiazide. An abdominal positron emission tomography-computed tomography scan showed a hypermetabolic nodule in the proximal portion of the body of the pancreas, compatible with focal congenital hyperinsulinism. A heterozygous mutation in the ABCC gene (Ala1516Glyfs*19) frameshift type inherited from the father was identified, which supported this diagnosis. Laparoscopy-assisted surgery was performed with ICG-guided near-infrared fluorescence, with intravenous injection of 16 mg ICG (2 mg/mg), which allowed localization of the focal lesion in the body of the pancreas. The lesion was resected with bipolar electrocautery and intraoperative histological study confirmed complete resection. Plasma glucose values normalized 6 hours after surgery and the patient was discharged 5 days later. In conclusion, the use of ICG in the treatment of congenital hyperinsulinism helps to identify hypermetabolic pancreatic nodules, decreasing the likelihood of incomplete resection.
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Affiliation(s)
- Carlos Delgado-Miguel
- Department of Pediatric Surgery, La Paz Children's University Hospital, Madrid, Spain
| | - Antonio Muñoz-Serrano
- Department of Pediatric Surgery, La Paz Children's University Hospital, Madrid, Spain
| | - Lucas Moratilla
- Department of Pediatric Surgery, La Paz Children's University Hospital, Madrid, Spain
| | | | - Miriam Miguel-Ferrero
- Department of Pediatric Surgery, La Paz Children's University Hospital, Madrid, Spain
| | - Nuria Leal
- Department of Pediatric Surgery, La Paz Children's University Hospital, Madrid, Spain
| | - Saturnino Barrena
- Department of Pediatric Surgery, La Paz Children's University Hospital, Madrid, Spain
| | - Leopoldo Martínez
- Department of Pediatric Surgery, La Paz Children's University Hospital, Madrid, Spain.,Institute for Biomedical Research La Paz (IdiPaz), Network for Maternal and Children Health (SAMID), La Paz Children's Hospital, Madrid, Spain
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Velayos M, Estefanía K, Álvarez M, Sarmiento MC, Moratilla L, Sanabria P, Hernández F, López Santamaría MV. Healthcare staff as promoters of parental presence at anesthetic induction: Net Promoter Score survey. World J Clin Pediatr 2021; 10:159-167. [PMID: 34868892 PMCID: PMC8603640 DOI: 10.5409/wjcp.v10.i6.159] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 04/06/2021] [Accepted: 07/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Surgical intervention is usually a traumatic event that causes stress and anxiety in the pediatric patient and the family environment. To reduce the harmful effects of presurgical anxiety, parental presence during induction of anesthesia (PPIA) is one of the more notable interventions used in medical centers. However, data on this measure are difficult to evaluate and often face resistance from healthcare staff.
AIM To analyze the perception of the healthcare workers after the implementation of a PPIA program.
METHODS A survey was developed and sent by email to all the healthcare staff working in the children’s area of a tertiary hospital. It consisted of 14 items divided into positive aspects of PPIA and negative aspects of PPIA evaluated with the use of a Likert scale (1 to 5). The demographics of the respondents were included in the data collected. The answers to the questions were interpreted through the Net Promoter Score (NPS). The statistical analysis compared the differences in the responses to each question of the survey made by the different groups of health personnel included.
RESULTS A total of 141 surveys were sent out, with a response rate of 69%. Of the total number of responses, 68% were from women and 32% from men. The average age of the participants was 42.3 ± 10.6 years. As for the positive questions about the PPIA, 83% had an NPS > 50, and only one had a score between 0 and 50, which means that the quality of the service was rated as excellent or good by 100% of the respondents. On the other hand, 100% of the negative questions about the PPIA had a negative NPS. Responses to the question “PPIA increases patient safety” were significantly different (P = 0.037), with a lower percentage of pediatric surgeons (70%) thinking that PPIA increased patient safety, compared with anesthesiologists (90%), nursing (92%), and other medical personnel (96%).
CONCLUSION The personnel who participated in the PPIA program at our center were in favor of implementation. There were no validated arguments to support worker resistance to the development of the PPIA.
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Affiliation(s)
- María Velayos
- Servicio de Cirugía Pediátrica, Hospital Universitario La Paz, Madrid 28046, Spain
| | - Karla Estefanía
- Servicio de Cirugía Pediátrica, Hospital Universitario La Paz, Madrid 28046, Spain
| | - María Álvarez
- Servicio de Cirugía Pediátrica, Hospital Universitario La Paz, Madrid 28046, Spain
| | - María C Sarmiento
- Servicio de Cirugía Pediátrica, Hospital Universitario La Paz, Madrid 28046, Spain
| | - Lucas Moratilla
- Servicio de Cirugía Pediátrica, Hospital Universitario La Paz, Madrid 28046, Spain
| | - Pascual Sanabria
- Servicio de Anestesia y Reanimación Infantil, Hospital Universitario La Paz, Madrid 28046, Spain
| | - Francisco Hernández
- Servicio de Cirugía Pediátrica, Hospital Universitario La Paz, Madrid 28046, Spain
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Arce A, Estirado A, Ordobas M, Sevilla S, García N, Moratilla L, de la Fuente S, Martínez AM, Pérez AM, Aránguez E, Iriso A, Sevillano O, Bernal J, Vilas F. Re-emergence of leishmaniasis in Spain: community outbreak in Madrid, Spain, 2009 to 2012. Euro Surveill 2013; 18:20546. [DOI: 10.2807/1560-7917.es2013.18.30.20546] [Citation(s) in RCA: 152] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Since July 2009, there has been a community outbreak of leishmaniasis in the south-west area of the Madrid autonomous community, Spain, affecting residents from four towns that are geographically close together and share extensive park areas. As of December 2012, 446 cases were reported (6 in 2009, 97 in 2010, 196 in 2011 and 147 in 2012), a mean incidence rate of 22.2 per 100,000 inhabitants during July 2009 and December 2012. The mean age was 44 years (range: 2 months to 95 years); 61.0% were male. A total of 68 (15.2%) had immunosuppressive conditions; 160 (35.9%) had visceral leishmaniasis and 286 (64.1%) cutaneous. A total of 421 (94.4%) cases were confirmed. Leishmania infantum was identified as the agent. Monitoring revealed high densities of the vector Phlebotomus perniciosus. The surveillance system for canine leishmaniasis did not detect any increase in prevalence during the period. Environmental control measures have been taken, such as improvements in sanitation and disinsection in the risk areas and control of the overpopulation of Leporidae, as xenodiagnosis studies have shown that hares play a role as active reservoirs. This is the largest reported community outbreak of leishmaniasis in Europe. The discovery of the new reservoir stands out in the multifactorial aetiology of the outbreak. Epidemiological research and environmental intervention measures are continuing.
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Affiliation(s)
- A Arce
- Division of Epidemiology, Health Promotion and Prevention Subdirectorate, Primary Care Directorate, Madrid, Spain
| | - A Estirado
- Division of Epidemiology, Health Promotion and Prevention Subdirectorate, Primary Care Directorate, Madrid, Spain
| | - M Ordobas
- Division of Epidemiology, Health Promotion and Prevention Subdirectorate, Primary Care Directorate, Madrid, Spain
| | - S Sevilla
- Division of Epidemiology, Health Promotion and Prevention Subdirectorate, Primary Care Directorate, Madrid, Spain
| | - N García
- Division of Epidemiology, Health Promotion and Prevention Subdirectorate, Primary Care Directorate, Madrid, Spain
| | - L Moratilla
- Division of Epidemiology, Health Promotion and Prevention Subdirectorate, Primary Care Directorate, Madrid, Spain
| | - S de la Fuente
- Division of Health Environmental, Ordination and Inspection Directorate, Health Department, Madrid, Spain
| | - A M Martínez
- Division of Health Environmental, Ordination and Inspection Directorate, Health Department, Madrid, Spain
| | - A M Pérez
- Division of Epidemiology, Health Promotion and Prevention Subdirectorate, Primary Care Directorate, Madrid, Spain
| | - E Aránguez
- Division of Health Environmental, Ordination and Inspection Directorate, Health Department, Madrid, Spain
| | - A Iriso
- Division of Health Environmental, Ordination and Inspection Directorate, Health Department, Madrid, Spain
| | - O Sevillano
- Division of Health Environmental, Ordination and Inspection Directorate, Health Department, Madrid, Spain
| | - J Bernal
- Division of Health Environmental, Ordination and Inspection Directorate, Health Department, Madrid, Spain
| | - F Vilas
- Division of Health Environmental, Ordination and Inspection Directorate, Health Department, Madrid, Spain
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