Anales españoles de pediatría
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Bronchiolitis is the leading cause of lower respiratory tract infection in infants and produces significant morbidity. Limited progress has been made in the treatment of this disease and, in many cases, the therapy employed is controversial and mainly based on general recommendations and not on evidence-based strategies. This report uses evidence-based methodology to provide a critical review of the data available on the treatment of acute bronchiolitis (understood as the first episode of respiratory syncytial virus bronchiolitis in a previously healthy infant). ⋯ Other therapies such us physiotherapy, nebulization, heliox, anticholinergics or exogenous surfactant, among others, require further randomized controlled trials to determine their utility. No evidence supports the routine use of corticosteroids, beta-adrenergic drugs, antibiotics, immunoglobulins, interferon, vitamin A or ribavirin in these patients. Finally, we consider that a national consensus review for the implementation of evidence-based clinical practical guidelines on the management of acute bronchiolitis would be of great interest.
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A newborn diagnosed with D-transposition of the great arteries underwent an arterial switch operation when she was 7-days old. The coronary pattern was of type 2, with right coronary and circumflex arteries from the right sinus and anterior descending artery from the left sinus. ⋯ Bolus and continuous infusion of intravenous lidocaine successfully terminated all episodes of ventricular tachycardia. At 6 months' follow-up the electrocardiogram was normal, without signs of myocardial ischemia or myocardial necrosis and without recurrence of ventricular tachycardia.
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To assess adrenal function in children with sepsis and septic shock with petechiae and to investigate the possible relationship between adrenal hypofunction, sonographic diagnosis of massive bilateral adrenal hemorrhage, and other factors available early in this disturbance. ⋯ Plasma cortisol and ACTH levels were increased in children with sepsis and septic shock. Adrenal insufficiency was uncommon. Adrenal insufficiency was associated with severe hemodynamic failure, necrotic purpura, disseminated intravascular coagulopathy, massive bilateral adrenal hemorrhage and high mortality rate.
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Evidence-based medicine is a new scientific paradigm that aims to use medical literature more effectively in guiding medical practice. The aim of this study was to assess the quality of scientific evidence in Spanish pediatric articles. Original articles published in Anales Españoles de Pediatría during a 6.5year period (n733) were compared with those published in Pediatrics during a 1.5year period (n300). ⋯ The pediatric specialty showing the highest quality of scientific evidence, greatest use of appropriate methodological concepts and greatest statistical accessibility was pneumology. The first step in improving the quality of scientific evidence would be to establish collaboration between epidemiologists and/or biostatisticians. The evidence-based bibliometric indicators found in Pediatrics serve as a gold standard for Anales.