[Iodine nutritional status in the school-aged population in Alicante (Spain)]. / Situación nutricional de yodo en la población escolar de Alicante.

BACKGROUND: According to the World Health Organization (WHO), goiter is endemic in Spain. The main cause of endemic goiter is iodine deficiency, which is also the principal cause of mental retardation and avoidable cerebral palsy throughout the world. MATERIAL AND METHODS: We conducted an observational study to determine the prevalence of endemic goiter and nutritional iodine status in the province of Alicante. Urinary iodine excretion was measured in a morning urine sample, and thyroid volume was measured by means of a thyroid ultrasound scan. A case of goiter was diagnosed if thyroid volume was above the 97th percentile adjusted by age, as published by the WHO. RESULTS: No cases of goiter were found. In addition, the median urinary iodine excretion levels adjusted by age were within the normal range, as defined by the WHO's criteria. CONCLUSIONS: Endemic goiter was not found in the province of Alicante and urinary iodine excretion values demonstrated adequate iodine intake. Further ultrasound studies are needed to establish reference thyroid volumes for our population.

[Cerebrovascular stroke as a sign of atrial myxoma in childhood]. / Accidente cerebrovascular como manifestación de mixoma auricular.

Primary cardiac tumors are uncommon with an estimated incidence of between 0.0017 % and 0.19 %. Most are benign. Whereas myxomas are the most common primary tumor in adults, in children they are exceptionally rare. Cardiac myxomas usually develop in the left atrium, 20 % occur in the right atrium and the remainder develops in the ventricles and rarely in the heart valves. Cerebrovascular strokes secondary to myxoma are rare in childhood. The diagnostic test of choice is transesophageal echocardiogram and early excision is the most effective treatment in preventing serious complications. We report a case of cerebral stroke as the only manifestation of an atrial myxoma in an 11-year-old-girl. The patient presented vertigo, right hemiparesis of the body and dysarthria without loss of consciousness. After diagnostic tests (computerized tomography, magnetic resonance imaging and cerebral angioresonance) she was diagnosed with an ischemic lesion in the left middle cerebral artery. Various investigations were performed to find the cause of the stroke, among them cardiologic study, and a mass in the left atrium suggestive of myxoma was found. The tumor was removed and the diagnosis of myxoma was confirmed by histopathological examination. Outcome was satisfactory. The presence of a cerebral ischemic episode, with or without concomitant heart disease, suggests the need to look for cardiac etiology.

[Diagnostic utility of radiography in head trauma: a critical review of the literature]. / Utilidad diagnóstica de la radiografía en el traumatismo craneal. Una revisión crítica de la bibliografía.

INTRODUCTION: The indication of distinct imaging studies in pediatric head trauma, and especially the use of skull radiography, is controversial. OBJECTIVE: To assess the effectiveness of skull radiography in the management of head trauma in pediatric patients. To do this, we aimed to determine the predictive value of this procedure in detecting intracranial injuries, independently of patients' symptoms and clinical examination. MATERIAL AND METHODS: We performed a review of the medical literature (MEDLINE) and of other resources available for searching biomedical information. Studies limited to pediatric patients (0-18 years old) that provided information on the diagnostic utility of skull radiography in head injury were selected. The source and characteristics of the populations studied and potential design limitations were taken into account. RESULTS: Twelve original studies were selected, three of which were performed in children younger than two years old. Differences were found in the origin of the sample populations, the prevalence of intracranial injury and skull fracture, the severity of the trauma included, and in the criteria for performing imaging tests. CONCLUSIONS: Because of the limited comparability of the articles, the usefulness of skull radiography was difficult to assess. Although the use of this technique is accepted in some circumstances in patients younger than two years old, the data obtained assign little value to the systematic use of radiography to assess head trauma in pediatric patients. Head computed tomography is indicated when symptoms or signs of possible neurological injury are present.

[Familial hypomagnesemia with hypercalciuria and nephrocalcinosis]. / Hipomagnesemia familiar con hipercalciuria y nefrocalcinosis.

Familiar hypomagnesemia with hypercalciuria and nephrocalcinosis is a rare syndrome belonging to the group of heterogeneous tubular diseases whose common characteristic is renal magnesium wasting. We present a 9 year old boy with polyuria, polydipsia and enuresis. Radiologic and ultrasonographic examinations showed nephrocalcinosis. Hypomagnesemia, normokaliemia, hypermagnesiuria, hypercalciuria, incomplete distal tubular acidosis, hypocitraturia and mild renal failure were found. Treatment with magnesium salts, hydrochlorothiazide, potassium citrate and sodium bicarbonate did not restore magnesium or calcium levels to normal. Renal function and nephrocalcinosis remain stable after 3 year's treatment. In conclusion, we report a new case of this rare syndrome caused by a congenital defect in magnesium reabsorption and discuss the evolution of the illness during 3 years' treatment.

[Technetium-99m-dimercaptosuccinic acid (DMSA) scintigraphy in the first febrile urinary tract infection in children]. / Gammagrafía con tecnecio-99m-ácido dimercaptosuccínico en el estudio de la primera infección urinaria febril del niño.

OBJECTIVE: The objective of this study was to evaluate the findings of 99mTc-DMSA renal scintigraphy in children with their first acute febrile urinary tract infection in relation with several clinical-biological parameters and other imaging studies and a long-term follow up. MATERIAL AND METHODS: 103 children between 1 month and 10 years old with their first acute febrile urinary tract infection were studied by means of clinical and laboratory assessment, renal ultrasonography and 99mTc DMSA renal scintigraphy in the acute illness period. Patients were divided into two groups, those under 2 years old (n = 63) and those over 2 years old (n = 40). RESULTS: Cortical scintigraphy showed renal changes in 56 patients (54,5%). Children over 2 years of age had a higher incidence of renal lesions than younger children (39,7% vs. 77,5%). Ultrasonography measuring renal volume showed a simple concordance with scintigraphy in 64% of the patients. Reflux was demonstrated in 23 patients (22,3%) without differences between patients with normal or abnormal cortical scintigraphy. After having studied the factors that were associated independently to the pathological results in the scintigraphy through a logistical multivariant regression, it was observed that the child's age, the elevation of the PCR and the alterations of the renal volume were significant according to statistics and also associated to a larger amount of pathological DMSA scintigraphy. CONCLUSIONS: DMSA scintigraphy associated with other diagnostic methods can improve the sensitivity and specificity to establish renal damage stage. During the follow-up the acute lesions disappeared or improved in all cases and the chronic lesions have not been modificated.

[Ethnic difference in attendance at emergency departments. An approximation to the gypsy reality]. / Diferencia étnica en la actividad asistencial de urgencias. Aproximación a la realidad gitana.

BACKGROUND: Demand for emergency services is increasing, especially among children from non-Caucasian ethnic groups. OBJECTIVES: To objectify this observation and to determine the healthcare and social differences between the gypsy and Caucasian populations. METHODS: We performed a descriptive, observational study in the Pediatric Emergency Unit of a tertiary care hospital. Systematic sampling was performed and 420 children were selected. Data on age, sex, compliance with primary healthcare preventive programs, reason for attendance, type of healthcare center, diagnosis and familial characteristics were collected through a questionnaire. RESULTS: The median age of the patients was 24 months. The percentage of patients of gypsy race was 16.4 %. Most of the gypsy population (68.1 %) attended small, local healthcare centers compared with 34.8 % of the Caucasian population (p 0.0001). Only 58 % of the gypsy children were taken to healthcare centers for regular check-ups compared with 96.7 % of the non-gypsy population (p 0.0001). The percentage of gypsy children who had never being vaccinated was 18.8 %. There were no such cases among the non-gypsy population (p 0.0001). The percentage of gypsy children visiting the emergency unit who were hospitalized was 11.6 % compared with 1.9 % of non-gypsy children. Illiteracy rates were 30.4 % and 15.9 % in gypsy mothers and fathers, respectively, compared with 0.6 % and 0.3 % in non-gypsy mothers and fathers, respectively (p 0.0001). CONCLUSIONS: This study reveals significant differences between the gypsy and Caucasian pediatric populations in terms of healthcare and identifies a group at high health risk.

Situación nutricional de yodo en la población escolar de Alicante / Iodine nutritional status in the school-aged population in Alicante (Spain)

Antecedentes Según la Organización Mundial de la salud (OMS), España se consideró un país afectado de endemia bociosa. El déficit de yodo es el responsable de dicha endemia además de ser la principal causa de retraso mental y parálisis cerebral evitable en el mundo. Material y métodos Estudio observacional para determinar la prevalencia de bocio endémico y el estado nutricional de yodo en la provincia de Alicante. Para ello se midió la yoduria en una muestra aislada y el volumen tiroideo mediante ecografía. Se consideró bocio todo volumen tiroideo superior al percentil 97 por edad publicado por la OMS. Resultados No se ha encontrado ningún caso de bocio. Así mismo las cifras de yoduria obtenidas también pueden ser consideradas dentro de la normalidad bajo los criterios de la OMS. Conclusiones Se puede decir que la provincia de Alicante no padece endemia bociosa y que además las cifras de yoduria demuestran una adecuada ingesta de yodo. Se evidencia la necesidad de realizar más estudios ecográficos de tiroides en otras zonas para establecer volúmenes tiroideos de referencia para nuestra población

Background According to the World Health Organization (WHO), goiter is endemic in Spain. The main cause of endemic goiter is iodine deficiency, which is also the principal cause of mental retardation and avoidable cerebral palsy throughout the world. Material and methods We conducted an observational study to determine the prevalence of endemic goiter and nutritional iodine status in the province of Alicante. Urinary iodine excretion was measured in a morning urine sample, and thyroid volume was measured by means of a thyroid ultrasound scan. A case of goiter was diagnosed if thyroid volume was above the 97th percentile adjusted by age, as published by the WHO. Results No cases of goiter were found. In addition, the median urinary iodine excretion levels adjusted by age were within the normal range, as defined by the WHO's criteria. Conclusions Endemic goiter was not found in the province of Alicante and urinary iodine excretion values demonstrated adequate iodine intake. Further ultrasound studies are needed to establish reference thyroid volumes for our population

Bocio endémico en la Comunidad Valenciana. Réplica / Endemic goiter in the autonomous community of Valencia (Spain). Reply

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Fibrosis endomiocárdica o enfermedad de Davies / Endomyocardial fibrosis or Davies’ disease

No disponible

Histiocitosis sinusal con linfadenopatía masiva y manifestaciones extraganglionares / Sinus histiocytosis with massive lymphadenopathy (SHML) with extranodal manifestations in an 8-year-old boy

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Utilidad diagnóstica de la radiografía en el traumatismo craneal. Una revisión crítica de la bibliografía / Diagnostic utility of radiography in head trauma: a critical review of the literature

Introducción La indicación de las distintas pruebas de imagen en el traumatismo craneoencefálico (TCE) pediátrico, y en especial la radiografía de cráneo, es motivo de controversia. Objetivo: Evaluar efectividad de la radiografía en el manejo del TCE en edad pediátrica. Para ello se tratará de determinar su valor predictivo en la detección de lesiones intracraneales, independientemente de la sintomatología y la exploración clínica del paciente. Material y métodos: Tras realizar una revisión de la literatura médica (MEDLINE), y otros recursos de búsqueda disponibles en internet, se seleccionaron los trabajos limitados a edad pediátrica (0-18 años) que aportaran información sobre el rendimiento diagnóstico de la radiografía de cráneo en el TCE. Se recogieron el origen y las características de la población en estudio, y las posibles limitaciones de diseño. Resultados: Se seleccionaron 12 trabajos originales, tres de los cuales se referían a menores de 2 años. Se encontraron diferencias en el origen de las poblaciones muestrales, prevalencia de lesión intracraneal y fractura de cráneo, gravedad de los traumatismos incluidos, y en los criterios de realización de pruebas de imagen. Conclusiones: La escasa comparabilidad entre los artículos dificulta la evaluación del rendimiento de la radiografía de cráneo. Aunque se admite su utilización ante algunas circunstancias en el grupo de menores de 2 años, los datos obtenidos confieren un escaso valor a la realización sistemática de radiografía en la valoración del traumatismo craneal en edad pediátrica. La tomografía computarizada constituye la prueba de referencia ante la presencia de síntomas o signos de posible lesión neurológica (AU)

Gammagrafía con tecnecio-99m-ácido dimercaptosuccínico en el estudio de la primera infección urinaria febril del niño / Technetium-99m-dimercaptosuccinic acid (DMSA) scintigraphy in febrile first-time urinary tract infection in children

Objetivo: Evaluar los hallazgos de la gammagrafía renal (DMSA) en niños con una primera infección del tracto urinario (ITU) febril en relación con diversos parámetros clínico-biológicos y otros estudios de imagen y seguimiento a largo plazo. Material y métodos: En un grupo de 103 pacientes (con edades comprendidas entre un mes y 10 años) con una primera ITU febril, se han evaluado parámetros clínicos, analíticos y pruebas de imagen en la fase aguda de la enfermedad. Los pacientes se dividieron en dos grupos de edad, menores (n = 63) y mayores de 2 años (n = 40). Resultados: La gammagrafía fue patológica en el 54,5 por ciento del grupo total, en el 39,7 por ciento en menores de 2 años y en el 79,5 por ciento de los mayores de 2 años. En la ecografía con medición del volumen renal se detectó una concordancia simple con la gammagrafía en el 64 por ciento de los casos. La cistografía objetivó un reflujo en el 22,3 por ciento de los pacientes, sin encontrar diferencias estadísticamente significativas entre los que presentaron un DMSA normal o patológico. Al estudiar los factores que se asociaron de forma independiente a un resultado patológico en el DMSA mediante un análisis multivariante de regresión logística, se observó que la edad del niño, la elevación de la proteína C reactiva (PCR) y la alteración del volumen renal resultaron asociarse de forma estadísticamente significativa a una mayor presencia de DMSA patológico. Conclusiones: El DMSA combinado con otras pruebas diagnósticas puede mejorar la sensibilidad y especificidad para establecer el grado de afectación renal. Durante el seguimiento, las lesiones agudas desaparecen o mejoran en todos los casos y las crónicas no se modifican (AU)

Hipomagnesemia familiar con hipercalciuria y nefrocalcinosis / Familial hypermagnesemia with hypercalciuria and nephrocalcinosis

La hipomagnesemia familiar con hipercalciuria y nefrocalcinosis es un síndrome poco frecuente que pertenece a un grupo de tubulopatías de naturaleza heterogénea, cuya característica común es la pérdida urinaria de magnesio. Se presenta el caso de un niño de 9 años de edad con sintomatología de poliuria, polidipsia y enuresis. Existía nefrocalcinosis ecográfica y radiológica. Se encontró hipomagnesemia, normopotasemia, hipermagnesiuria, hipercalciuria, acidosis tubular distal incompleta, hipocitraturia e insuficiencia renal leve. El tratamiento con sales de magnesio, hidroclorotiacida, citrato potásico y bicarbonato sódico no ha conseguido normalizar ni la magnesiuria ni la calciuria. La función renal y la nefrocalcinosis permanecen estables tras 3 años de control. Se trata de un nuevo caso de este raro síndrome producido por un defecto congénito de la resorción tubular de magnesio, y su evolución clínica y analítica tras 3 años de seguimiento (AU)