F de Juan Martín

Hospital Universitario Miguel Servet, Caesaraugusta, Aragon, Spain

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Publications (56)24.99 Total impact

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    ABSTRACT: Introduction and objectives: Respiratory syncytial virus (RSV) infections are well characterized in infants. However, few studies are focused in RSV disease in children over 2 of age. Our goal is to analyze the characteristics of children older than 2 hospitalized due to RSV infection in the context of the FIVE study. Patients and methods: This is a substudy of the FIVE study (prospective, observational, and multicenter) performed in 26 hospitals in all Spanish regions, between December 2011 and March 2012. In the FIVE study, children under 5 years of age hospitalized due to RSV infection were analyzed, comparing patients with underlying conditions (clinical cases) with a group of previously healthy children (ratio 1/2). In this occasion, 2-5 year-old children were more widely analyzed. Results: A total of 225 cases and 460 controls were included in the FIVE study. Among those, 70 children were >2 years old (10.2%). The mean age was 35 months (SD = 9), 58% were male and 23% had a history of prematurity. Breathlessness was the cause of hospitalization in 78% of cases. Hypoxemia (SatO2 <92%) was present in 80%. Eight children (11.6%) were admitted to PICU and one of them died. The most common discharge diagnose was recurrent wheezing episode (62%), followed by pneumonia in 30%. 77% of children (54) had an underlying disease (OR = 8.74; 95% CI: 4.8 to 15.7; p <0.0001). The most common underlying diseases observed were respiratory (66%), cardiovascular (20%) and neurologic (11 %). The most frequent respiratory disease observed was asthma (59%). Conclusions: Children >2 years hospitalized due to RSV infection are at risk from having underlying disease 8.7 times more than the <2 years. The most common underlying pathology is asthma. The most common diagnosis is an episode of recurrent wheezing and most patients need oxygen therapy.
    No preview · Article · Jan 2015 · Acta pediátrica española
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    ABSTRACT: Objectives. Kala azar o visceral leishmaniasis (LV) is one of the most neglected disease in the world. In developing countries, 350 million people are at risk of having LV and 2 million cases are reported every year. In Spain, since 1982 LV has become a compulsory notifiable disease with around 90 cases reported every year. In 1995, it was declared notifiable disease in endemic areas and one of them was Aragón. Patients and Methods. Retrospective study of 14 VL cases. All of them in patients between 0-14 years old admitted into the Infectious Diseases Unit at Children's Hospital Miguel Servet in Zaragoza between January 1980 to December 2010. Results. A total of 16 children were admitted with the diagnosis of LV. The study was carried out with data of 14 of these patients. The mean age at diagnosis was 3 years (range 9 months-12 years, median 19 months). The 64% of them came from rural areas. At admission, they had 3700 leukocyte average with neutropenia in 71% of those cases. All of them (100%) were anemic with a 7.7 mg/dl hemoglobin/dl range but only nearly 77% has thrombocytopenia (<150,000 platelets/mm3). The 64% of the children debuted with pancytopenia. ESR rose were more than 20 mm/h in all cases. Bone marrow aspiration was done in all patients, showing parasite in every VL confirmed cases. Meglumine antimoniate was used as a treatment in all cases until 2010 when it was replace with liposomal amphotericin B. Both treatments has had good clinical response. Conclusions. Leishmaniasis is in our environment and Aragon is an endemic area. Clinical features are fever and splenomegaly, more than 60% of cases also showed pancytopenia. In our hospital parasite display remains the gold standard for the diagnosis even the PCR has shown better results in many studies. Treatment with amphotericin B is currently the treatment of choice in the mediterranean area.
    No preview · Article · Mar 2013 · Revista española de pediatría

  • No preview · Article · Nov 2012 · Anales de Pediatría
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    ABSTRACT: Objectives. Malaria remains a public health problem worldwide. According to WHO, 108 countries are endemic in the world. In Spain, the number of imported cases has grown steadily since the 70's due to increased immigration, tourism and seasonal working in endemic countries. Patients and methods. A retrospective of confirmed malaria cases in children admitted to the Infectious Diseases Unit of our hospital, between January 2000 and January 2010. Results. 51 children were admitted with the diagnosis of malaria. The mean age at diagnosis was 6 years (range: 11 months to 13 years). 92.3% of patients came from subSaharan Africa with prevalence of Equatorial Guinea (17 cases; 43.6%), In 35 cases (89.7%) a recent trip to his home country had been made, two of them having received antimalarial prophylaxis. There was fever in 71.8% of the cases, hepatomegaly in 59%, splenomegaly in 56.4% and 3 patients required admission to ICU, Thick smear was carried out as diagnostic initial method in 100% of the cases. Plasmodium falciparum stands out among the other affecting 71.8% of cases, followed by Plasmodium vivax (12.8%) and Plasmodium malarie (5.1%). Antigen detection of Plasmodium in blood was performed in 21 cases (53.8%) and none was performed to determine genomic PCR. The combination of quinine and pyrimethamine with sulfadioxine was applied in 61.5% of the sample. Concomitant intestinal parasitism was found in 8 cases. Conclusions. In our series, as in other series in our country, 92.3% of patients came from sub-Saharan Africa with prevalence of Equatorial Guinea and 89.7% comprised a recent trip to their country of origin. The thick smear was the most useful diagnostic method. An adequate prophylaxis (it had been performed just in 2 cases in our study) and a thorough screening of other associated parasitosis would be instrumental in fighting this disease.
    No preview · Article · Jan 2012 · Revista española de pediatría

  • No preview · Article · Jun 2010 · Anales de Pediatría

  • No preview · Article · Jun 2010 · Anales de Pediatría

  • No preview · Article · Dec 2009 · Anales de Pediatría

  • No preview · Article · Oct 2009 · Anales de Pediatría
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    ABSTRACT: Sobre la base de la evidencia disponible, un grupo de expertos informa y comenta las novedades que han ocurrido en el año 2008 en relación con las vacunas y aconseja las modificaciones del calendario vacunal para el año 2009. Se insiste en recomendar la administración de la segunda dosis de recuerdo de vacuna de varicela al inicio de la escolarización (3-4 años) y se reitera la importancia de universalizar la vacunación antineumocócica conjugada heptavalente, en consonancia con las incuestionables pruebas científicas existentes, la recomendación de la Organización Mundial de la Salud y la postura adoptada en la mayoría de los países europeos de nuestro entorno. Se aportan nuevas razones científicas, que apoyan la necesidad de implementar la vacuna frente al rotavirus y el virus del papiloma humano; respecto a esta última, se insiste en la vacunación desde los 11 años hasta los 16 años, ampliándola, en consonancia con las fichas técnicas de los preparados vacunales disponibles, hasta los 26 años. En estas recomendaciones vacunales, se insiste en dos vacunas, contra la gripe y la hepatitis A, que se debe indicar en niños que presentan riesgo. El grupo de expertos considera que las vacunas frente a la gripe y la hepatitis A deben administrarse cuando los pediatras lo consideren oportuno, más allá de los grupos de riesgo, como primer paso para una futura recomendación universal. Por último, se incluye un anexo sobre las recomendaciones y las estrategias vacunales que se deben seguir en el caso de niños no vacunados o inmunizados de forma incompleta.
    Full-text · Article · Jul 2009 · Vacunas
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    ABSTRACT: Based on the available evidence, we, the Vaccine Advisory Committee (CAV) of the Spanish Association of Pediatrics (Asociación Española de Pediatría, AEP), provide information about and comments on vaccine-related innovation during 2008. Modifications to the Vaccine Schedule for 2009 are also discussed. The importance of the recommendation of administration of a varicella booster at start of school (3-4 years of age) is highlighted according to the technical specifications of one of the vaccines. The importance of making the heptavalent pneumococcal conjugate vaccine universally available is reiterated in accordance with the unquestionable results of scientific tests, WHO recommendations, the posture adopted by the majority of neighboring European countries, and the decision taken in 2006 by the autonomous community of Madrid (Spain). New scientific reasons are provided, corroborating the recommendation made by this committee in 2008, for the implementation by Spanish pediatricians of the vaccine against rotavirus and human papilloma virus. With regard to the latter, vaccination should be from 11 to 16 years of age, and then extended, in accordance with the technical specifications of the available vaccine preparations, to 26 years of age. As part of the recommendations, we insist that children in risk groups should be given flu vaccine and hepatitis A vaccine. The committee considers that these two vaccines must also be given, when pediatricians consider it appropriate, to children other than those in risk groups. This recommendation can be regarded as the first step towards a future recommendation of universal vaccination. Finally, this year we include an appendix with recommendations and vaccination strategies to be followed in children who have not previously received vaccines or who have not been completely immunized.
    Full-text · Article · Feb 2009 · Anales de Pediatría

  • No preview · Article · Dec 2008 · Anales de Pediatría
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    ABSTRACT: Acute gastroenteritis (AGE) in infants has a significant impact on the quality of life of their parents. Cross-sectional study on the sociological family impact related to rotavirus AGE in children under 2 years. The study was carried out in 25 hospitals and 5 primary care centres in Spain. Sociodemographic, epidemiological and clinical data were recorded, as well as the symptomatology of AGE and its severity measured by the Clark scale. Stool samples were tested to determine rotavirus positive (RV+) or negative (RV-). The parents were asked to complete a a family impact questionnaire. Stool specimens were tested in 1087 AGE cases (584 RV+ vs 503 RV-). The 99.5 % of parents whose children were RV+ reported more worries vs. the 97.7 % of RV-, and RV+ had a higher importance score (p < 0.05). A higher percentage of RV+ parents and those with a high importance score reported more time dedicated to dehydration treatment (p < 0.05). The 82.5 % vs. 73.9 % had disruption of their household tasks, with more importance scores (p < 0.05). RV+ had a higher percentage and importance score than RV- ones in all aspects of their child's AGE symptoms, except loss of appetite. AGE produces important dysfunctional experiences in daily family life. According to parental perceptions, RV+ produces greater worries and dysfunctions in child behaviour.
    No preview · Article · Dec 2008 · Anales de Pediatría
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    Full-text · Article · Apr 2008 · Vacunas
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    ABSTRACT: There is a widespread perception among Spanish pediatricians that the incidence of empyema has significantly increased in the last few years, even though the objective information available is limited, and there is no specific active epidemiological surveillance system for this condition. In the present article, we review the situation of empyema in Spain, and discuss the main hypotheses put forward in the international literature to explain this increase, as well as the limitations of the sources available. Despite the scarcity of information, we draw the following conclusions: 1) the incidence of pediatric empyema is increasing in Spain, both generally and when caused by pneumococcus in particular; 2) the reason for this increase remains unknown, and to date no firm link has been established between this phenomenon and the heptavalent conjugate pneumococcal vaccine; and 3) this situation justifies the establishment of prospective systems for the surveillance and control of empyema and, once again, highlights the importance of developing active surveillance systems for pneumococcal disease.
    Full-text · Article · Mar 2008 · Anales de Pediatría
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    ABSTRACT: There is a widespread perception among Spanish pediatricians that the incidence of empyema has significantly increased in the last few years, even though the objective information available is limited, and there is no specific active epidemiological surveillance system for this condition. In the present article, we review the situation of empyema in Spain, and discuss the main hypotheses put forward in the international literature to explain this increase, as well as the limitations of the sources available. Despite the scarcity of information, we draw the following conclusions: 1) the incidence of pediatric empyema is increasing in Spain, both generally and when caused by pneumococcus in particular; 2) the reason for this increase remains unknown, and to date no firm link has been established between this phenomenon and the heptavalent conjugate pneumococcal vaccine; and 3) this situation justifies the establishment of prospective systems for the surveillance and control of empyema and, once again, highlights the importance of developing active surveillance systems for pneumococcal disease.
    Full-text · Article · Feb 2008 · Anales de Pediatría
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    ABSTRACT: The Vaccine Advisory Committee of the Spanish Association of Pediatrics provides information on the new developments in vaccines that have taken place in 2007, based on the available evidence, and discusses these developments. Certain modifications to the Immunization Schedule for 2008 are recommended. A second varicella vaccine booster dose, administered together with the booster dose of the measles-mumps-rubella (MMR) vaccine when children start school (3-4 years), is recommended to avoid vaccine failures against the varicella-zoster virus. Based on current scientific evidence, the importance of universal heptavalent conjugate pneumococcal vaccination, as carried out in most similar European countries and in the autonomous community of Madrid in Spain, is stressed. Human papilloma virus vaccine is included in the Immunization Schedule for girls from 11 years old, and initially, at least up to the age of 16 years. Vaccination against rotavirus in children starting at 6 weeks and completing the series before 6 months is recommended. Other recommendations included in this year's Immunization Schedule are vaccination against influenza and hepatitis A virus in risk groups and at the pediatrician's discretion, as a first step toward the future recommendation of universal immunization.
    Full-text · Article · Feb 2008 · Anales de Pediatría
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    ABSTRACT: The Vaccine Advisory Committee of the Spanish Association of Pediatrics analyzes and discusses the criteria followed when preparing their yearly Recommended Immunization Schedule for children and adolescents. The relative importance of each criterion in the final recommendation is assessed. Following a review of the current state of affairs of childhood immunization in Spain and of the crucial role played by pediatricians, some reflections are presented on the problems derived from the vaccines recommended by this Committee but not covered by the national health system. Suggestions are made for individual pediatricians who may need to establish specific priorities in the recommendation of these vaccines.
    Full-text · Article · Feb 2008 · Anales de Pediatría
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    ABSTRACT: Influenza is frequent during childhood, affecting approximately 30-40 % of children. To identify the most frequent causes of hospitalization in children admitted to hospital for influenza, as well as the main symptoms and clinical diagnoses at discharge, and to relate these factors with the type of influenza virus and patients' age. A further aim was to evaluate the use of the diagnostic and therapeutic methods. We performed a retrospective descriptive study through a review of the medical records of children admitted to the Miguel Servet Children's Hospital in Zaragoza (Spain) for influenza in four epidemic seasons (2002-2006). A total of 178 influenza cases were found, 132 due to influenza A and 46 due to influenza B. Hospital admission was mainly due to fever without focus, especially in infants aged less than 6 months, followed by convulsions and shortness of breath. The main symptoms were fever, cough, rhinitis, and vomiting. The latter was especially frequent in children older than 3 years and in patients with influenza B virus. The main discharge diagnoses were upper respiratory tract infection, pharyngitis-tonsillitis, and otitis. Diagnosis of bronchitis was more frequent in children aged less than 2 years old. Chest X-ray was performed in 80% of the patients and lung consolidation was found in 10.5%. Antibiotic therapy was administered in 59% of the patients, mainly amoxicillin-clavulanic acid. The causes of admission for influenza and clinical presentation of this infection vary widely, sometimes depending on age and the type of influenza virus.
    No preview · Article · Feb 2008 · Anales de Pediatría
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    ABSTRACT: Introduction Influenza is frequent during childhood, affecting approximately 30-40% of children. Objectives To identify the most frequent causes of hospitalization in children admitted to hospital for influenza, as well as the main symptoms and clinical diagnoses at discharge,and to relate these factors with the type of influenza virus and patients’ age. A further aim was to evaluate the use of the diagnostic and therapeutic methods. Material and methods We performed a retrospective descriptive study through a review of the medical records of children admitted to the Miguel Servet Children's Hospital in Zaragoza (Spain) for influenza in four epidemic seasons (2002-2006). Results A total of 178 influenza cases were found, 132 due to influenza A and 46 due to influenza B. Hospital admission was mainly due to fever without focus, especially in infants aged less than 6 months, followed by convulsions and shortness of breath. The main symptoms were fever, cough, rhinitis, and vomiting. The latter was especially frequent in children older than 3 years and in patients with influenza B virus. The main discharge diagnoses were upper respiratory tract infection, pharyngitis-tonsillitis, and otitis. Diagnosis of bronchitis was more frequent in children aged less than 2 years old. Chest X-ray was performed in 80 % of the patients and lung consolidation was found in 10.5 %. Antibiotic therapy was administered in 59 % of the patients, mainly amoxicillin-clavulanic acid. Conclusions The causes of admission for influenza and clinical presentation of this infection vary widely, sometimes depending on age and the type of influenza virus.
    No preview · Article · Jan 2008 · Anales de Pediatría
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    ABSTRACT: El Comité Asesor de Vacunas de la Asociación Española de Pediatría analiza y discute los criterios que siguen en la elaboración de su calendario vacunal recomendado cada año. Se argumenta la importancia relativa de cada uno de estos criterios en la recomendación final. Se analiza la situación actual de la vacunación infantil en España y el papel desempeñado por los pediatras. Se reflexiona sobre los problemas generados por las vacunas recomendadas por este comité y que no son financiadas por el sistema sanitario, y se orienta sobre la actitud a seguir por parte de los pediatras ante la eventual necesidad de establecer prioridades individualizadas en la recomendación de estas vacunas.
    Full-text · Article · Jan 2008 · Anales de Pediatría

Publication Stats

193 Citations
24.99 Total Impact Points

Institutions

  • 1988-2012
    • Hospital Universitario Miguel Servet
      Caesaraugusta, Aragon, Spain
  • 2008
    • Conselleria de Sanidade
      La Corogne, Galicia, Spain
  • 2006
    • Sanofi Pasteur MSD
      Lyons, Rhône-Alpes, France