[Psychiatric patients in the pediatric emergency department of a tertiary care center: review of a 6-month period]. / Pacientes psiquiátricos en el servicio de urgencias de pediatría de un hospital terciario: revisión de un período de 6 meses.

INTRODUCTION: In the last few years, a marked increase in the number of psychiatric emergencies treated at pediatric emergency departments has been observed. The aim of the present study was to characterize these patients. PATIENTS AND METHODS: We performed a descriptive, prospective, cross sectional study, based on all psychiatric emergencies treated at the pediatric emergency department of Hospital General Universitario Gregorio Marañón, Madrid, from 1-10-04 to 31-3-05. The following variables were analyzed: age, sex, time of consultation, day of the week, day of the month, month of the year, psychiatric antecedents, previous psychiatric pharmacologic treatment, the person or service who took the child to hospital, diagnosis, and whether the patient was admitted to the hospital. RESULTS: Of a total of 36,449 emergencies, 79 were psychiatric (0.21 %). Sex rates were 48.1 % boys and 51.9 % girls. The mean (+/-2 SD) age was 13.73 +/- 2.5 years. Visits were most frequent on Mondays (19 %), in the evening, and in January and February. A total of 13.23 % of the patients were brought by extrahospital services. The main diagnoses were: behavioral disorders (36.76 %), anxiety disorders (20.58 %) and suicidal ideation or suicide attempt (13.23 %). There was a clear male predominance in behavioral disorders (67.85 %) and a female predominance in anxiety disorders (71.42 %) and suicidal ideation or suicide attempt (76.92 %). The hospitalization rate among these patients was 32.35 %. CONCLUSIONS: The incidence of psychiatric disorders in our pediatric emergency department was low. The patients were aged 11-15 years old, without differences between the sexes. Peak demand was reached on Mondays in January and February, at the end of the evening and beginning of the night. The most common diagnosis was behavioral disorder. The hospitalization rate was exceptionally high, more than 6 times higher than the average in our hospital.

Microbial diversity and activity in seafloor brine lake sediments (Alaminos Canyon block 601, Gulf of Mexico).

The microbial communities thriving in deep-sea brines are sustained largely by energy rich substrates supplied through active seepage. Geochemical, microbial activity, and microbial community composition data from different habitats at a Gulf of Mexico brine lake in Alaminos Canyon revealed habitat-linked variability in geochemistry that in turn drove patterns in microbial community composition and activity. The bottom of the brine lake was the most geochemically extreme (highest salinity and nutrient concentrations) habitat and its microbial community exhibited the highest diversity and richness indices. The habitat at the upper halocline of the lake hosted the highest rates of sulfate reduction and methane oxidation, and the largest inventories of dissolved inorganic carbon, particulate organic carbon, and hydrogen sulfide. Statistical analyses indicated a significant positive correlation between the bacterial and archaeal diversity in the bottom brine sample and NH4+ inventories. Other environmental factors with positive correlation with microbial diversity indices were DOC, H2 S, and DIC concentrations. The geochemical regime of different sites within this deep seafloor extreme environment exerts a clear selective force on microbial communities and on patterns of microbial activity.

[Comparison between conventional ph measurement and multichannel intraluminal esophageal impedance in children with respiratory disorders]. / Comparación entre pH-metría convencional e impedanciometría intraluminal multicanal en niños con patología respiratoria.

INTRODUCTION: Gastroesophageal reflux (GER) is associated with respiratory symptoms. The link between non-acid GER and the pathogenesis of respiratory disease has been demonstrated. Esophageal multichannel intraluminal impedance (MII) is able to detect non-acid and alkaline GER, as well as reflux height. The objective of the study was to compare the diagnostic effectiveness of dual-channel pH-meter and MII. PATIENTS AND METHODS: A prospective study was conducted on patients diagnosed with uncontrolled asthma, persistent cough, or chronic laryngitis. Patients were monitored continuously for 24 hours using a combination of MII and a dual-channel pH-meter. A descriptive and comparative analysis of the techniques was performed using the t test for comparison between groups and McNemar test for non-parametric data. RESULTS: A total of 49 patients with respiratory disease between September 2008 and April 2010 (79.6% uncontrolled asthma, 10.2% persistent cough, and 10.2% chronic laryngitis) were included in the study. The mean number of refluxes detected was 18.3 (range 0-93) using the pH-meter and 39.2 (11-119) using MII (P<.001). Acid GER was detected using pH in 7 children and using MII in 25 children (8 acid, 10 alkaline and 7 mixed). A mean of 21 proximal refluxes were detected using MII. CONCLUSIONS: MII makes it possible to diagnose a greater number of refluxes, whether acid or alkaline, than conventional pH measurement in children with respiratory disease that is poorly controlled with their usual treatment. MII can also detect proximal refluxes.

Comparación entre pH-metría convencional e impedanciometría intraluminal multicanal en niños con patología respiratoria / Comparison between conventional ph measurement and multichannel intraluminal esophageal impedance in children with respiratory disorders

Introducción: El RGE se asocia a sintomatología respiratoria; se ha demostrado la relación entre el RGE no ácido y su etiopatogenia. La impedancia intraluminal multicanal esofágica (MII) es capaz de detectar RGE no ácido y alcalino, así como la altura de ascenso del reflujo. Objetivo: Comparar la eficacia en el diagnóstico de reflujo gastroesofágico ácido y no ácido de la pH-metría bicanal y la MII en pacientes con patología respiratorio. Pacientes y métodos: Estudio longitudinal, prospectivo de pacientes con diagnóstico de asma persistente al tratamiento, tos crónica o laringitis de repetición. Se realizó monitorización continua durante 24 h mediante MII-pH-metría doble canal y análisis descriptivo de los datos comparando ambas técnicas entre sí. Se realizó un análisis descriptivo y comparativo mediante la prueba de la t de Student y el test de MacNemar como prueba no paramétrica. Resultados: Entre septiembre 2008 y abril 2010 se incluyó a 49 pacientes con patología respiratoria (79,6% asma crónica, 10,2% tos crónica y 10,2% laringitis). La media de reflujos detectados por pH-metría fue de 18,3 (rango 0-93) y por MII de 39,2 (11-119) (p<0,001). El índice sintomático fue 6,7% por pH-metría y 13,9% por MII (p<0,05). El número de niños diagnosticados de RGE ácido por pH-metría fue de 7 y mediante MII se diagnosticaron 25 niños (8 ácidos, 10 alcalinos y 7 mixtos). La media de reflujos proximales detectados por MII fue de 21. Conclusiones: La MII es capaz de diagnosticar mayor número de reflujos tanto ácidos como alcalinos que la pH-metría convencional en los niños con patología respiratoria resistente al tratamiento, así como detectar reflujos proximales(AU)

Introduction: Gastroesophageal reflux (GER) is associated with respiratory symptoms. The link between non-acid GER and the pathogenesis of respiratory disease has been demonstrated. Esophageal multichannel intraluminal impedance (MII) is able to detect non-acid and alkaline GER, as well as reflux height. The objective of the study was to compare the diagnostic effectiveness of dual-channel pH-meter and MII. Patients and methods: A prospective study was conducted on patients diagnosed with uncontrolled asthma, persistent cough, or chronic laryngitis. Patients were monitored continuously for 24hours using a combination of MII and a dual-channel pH-meter. A descriptive and comparative analysis of the techniques was performed using the t test for comparison between groups and McNemar test for non-parametric data. Results: A total of 49 patients with respiratory disease between September 2008 and April 2010 (79.6% uncontrolled asthma, 10.2% persistent cough, and 10.2% chronic laryngitis) were included in the study. The mean number of refluxes detected was 18.3 (range 0-93) using the pH-meter and 39.2 (11-119) using MII (P<.001). Acid GER was detected using pH in 7 children and using MII in 25 children (8 acid, 10 alkaline and 7 mixed). A mean of 21 proximal refluxes were detected using MII. Conclusions: MII makes it possible to diagnose a greater number of refluxes, whether acid or alkaline, than conventional pH measurement in children with respiratory disease that is poorly controlled with their usual treatment. MII can also detect proximal refluxes(AU)

Valoración de los test no invasivos en el diagnóstico de la infección por «Helicobacter pylori» en niños / Valuation of non-invasive tests to detect Helicobacter pylori infection in children

Introducción: La infección por Helicobacter pylori se adquiere frecuentemente durante la infancia. Nuestro objetivo era determinarla eficacia y la fiabilidad del test rápido de detección del antígeno de H. pylori en heces como alternativa al test del aliento en niños (gold standard no invasivo).Pacientes y métodos: Se incluyeron pacientes con clínica sugerente remitidos a nuestra consulta entre junio de 2006 y abril de 2007. Se realizaron test de detección rápida de anticuerpos IgG frente a H. pylori, test del aliento y detección rápida del antígeno de H. pylori en heces. Resultados: Nuestra muestra fue de 94 pacientes (un 57% eran niñas), con una media de edad de 10,4 ± 2,9 años (rango:2-16). Mediante test del aliento, 39 niños (41,5%) fueron diagnosticados de infección actual. El test de detección en heces diagnosticó a 28 pacientes (30%) y la serología a 40 (42,5%). La sensibilidad y la especificidad del test de heces fueron del 54 y el 87%, y para el test serológico del 74 y el 80%, respectivamente. La distribución de los niños según grupos de edad fue la siguiente: 8 menores de 6 años, 61 de entre 7 y 12 años, y 25 mayores de 12 años. Para el test en heces la sensibilidad fue del 75, 57 y 29%, y la especificidad del 100, 81 y 94%, respectivamente para cada grupo. Para la serología, la sensibilidad fue del 50, 82 y 57%, y la especificidad del 50, 82 y 83%, respectivamente. Conclusiones: La sensibilidad del test de detección en heces resultó inferior a la publicada previamente. En nuestra población, este test es más específico que sensible, y es más sensible cuanto menor es la edad del paciente. El test serológico resultó ser más sensible y específico en los niños >6 años (AU)

Introduction: Helicobacter pylori infection is often acquired during childhood. Our objective was to determine the effectiveness and reliability of a rapid antigen test of H. pylori in faeces as an alternative to the breath test in children (criteria of non invasive reference).Patients and methods: The patients enrolled where children with suggestive symptoms of H. pylori infection who were attended in our service from June 2006 to April 2007. Tests of rapid detection of antibodies of immunoglobulin G versus H. pylori had been performed, breath test and rapid antigen test of H. pylori in faeces. Results: Our sample included a total of 94 children, 57% female; mean age 10.4 ± 2.9 years (2-16). By means of a breath test 39 (41.5%) of the children were infected with H. pylori. The faeces test diagnosed 28 (30%) infected children and serology showed 40 (42.5%). The overall sensitivity and specificity of the faeces test were of 54% and 87% and 74% and 80% for the serology test. The children were arranged in different groups of age 8 children less than 6 years old, 61 with ages between 7-12 years of age and 25 children above 12 years old. For the faeces test sensitivity it was 75, 57 and 29% and specificity was 100, 81 and 94%, for these three age groups respectively. Serology sensitivity was 50, 82 and 57%, respectively, and the specificity was 50, 82 and 83%.Conclusions: The faeces test sensitivity in our study is less than the results of prior publications. In our children population the faeces test is more specific than sensitive and it is more sensitive in younger children. The serological test is more sensitive and specific in children >6 years old (AU)

Aspectos nutricionales y del aparato digestivo de los niños inmigrantes / Nutritional and gastrointestinal findings in immigrant children

La mayoría de los niños que llegan a España generalmente no presentan las tasas de desnutrición del país de origen, aunque sí determinadas carencias nutricionales específicas (hierro, vitamina A) y raquitismo. En la actualidad, el hecho de pertenecer a una minoría étnica no debería ser un factor de riesgo para padecer desnutrición carencial y, con la excepción de los hijos de los inmigrantes recién llegados, el estado nutricional y el crecimiento de estos niños han de ser similares a los de los niños con el mismo nivel socioeconómico del país de destino. Para un mejor control de los niños inmigrantes, los profesionales sanitarios deben conocer el estado nutricional de base(con la obtención de las distintas medidas antropométricas) y los aspectos genéticos y socioculturales, a fin de poder prevenir sus posibles alteraciones a largo plazo, ya que se están registrando importantes problemas de sobrepeso, especialmente en la segunda generación de esta población. También repasamos la patología abdominal en el niño inmigrante desde el punto de vista sindrómico, para poder orientar el diagnóstico y el tratamiento. Aunque en general es similar a la observada en la población autóctona, debido a las características propias ambientales y a la carga genética de estos niños podemos hallar diferencias en la prevalencia de algunas enfermedades, aparte de las afecciones propias del trópico. Además, son frecuentes las patologías reactivas o de adaptación, que se expresan fundamentalmente con somatizaciones y síntomas vagos que indican una problemática relacional, y el dolor abdominal es el síntoma más común en estos niños(AU)

In general, most of the children who arrive in Spain do not reflect the rates of malnutrition observed in their countries of origin, although certain specific nutritional deficiencies (iron, rickets, vitamin A) may be detected. At the present time, being a member of an ethnic minority should not be a risk factor for malnutrition owing to deficiency disease, and, with the exception of children of newly arrived immigrants, the nutritional status and growth of these children should be similar to that of children of the same socioeconomic status in the country of destination. For a more effective monitoring of immigrant children, health professionals should be aware of the baseline nutritional status(using different anthropometric measurements) and genetic and sociocultural aspects in order to prevent possible long-term disturbances, since these individuals are experiencing significant problems with overweight, especially those of the second generation. We also reviewed the gastrointestinal diseases that can be found in the immigrant child from the syndromic point of view in order to guide their diagnosis and treatment. Although, in general, they are similar to those observed in the native population, given the particular environmental characteristics and the genetic load of these children, we do detect differences in the prevalence of certain diseases, aside from those associated with the tropics. In addition, coping problems or adjustment disorders frequently occur and are expressed mainly in the form of somatization and vague symptoms that indicate relational problems, with abdominal pain being the most common symptom in these children(AU)

Pacientes psiquiátricos en el servicio de urgencias de pediatría de un hospital terciario: revisión de un período de 6 meses / Psychiatric patients in the pediatric emergency department of a tertiarycare center: review of a 6-month period

Introducción Se ha observado durante los últimos años un notable aumento en el número de urgencias psiquiátricas atendidas en los servicios de urgencias de pediatría. Realizamos este estudio con el objetivo de definir las características de estos pacientes. Pacientes y métodos Estudio descriptivo, prospectivo y transversal que incluyó todas las urgencias psiquiátricas atendidas en el servicio de urgencias de pediatría del Hospital General Universitario Gregorio Marañón de Madrid, desde el 1 de octubre de 2004 hasta el 31 de marzo de 2005. Se analizaron: edad, sexo, hora de la consulta, día de la semana, día del mes, mes, antecedentes psiquiátricos, tratamiento psiquiátrico farmacológico previo, acompañante del menor, diagnóstico y destino final del paciente. Resultados Se registraron 79 urgencias psiquiátricas sobre 36.449 urgencias totales (0,21 %). El 48,1 % eran niños y el 51,9 % niñas. La edad (media 62 DE) fue de 13,73 6 2,5 años. Se observó mayor demanda asistencial los lunes (19 %), por la tarde y en los meses de enero y febrero. El 13,23 % de los pacientes fueron traídos por servicios de urgencias extrahospitalarios. Los principales diagnósticos fueron: trastorno de conducta (36,76 %), trastorno de ansiedad (20,58 %) e ideación o intento autolítico (13,23 %). Se observó un claro predominio de niños en el trastorno de conducta (67,85 %) y de niñas en el trastorno de ansiedad (71,42 %) y en la ideación o intento autolítico (76,92 %). La tasa de hospitalización de los pacientes con patología psiquiátrica urgente fue del 32,35 %. Conclusiones Observamos una baja incidencia de patología psiquiátrica en nuestro servicio de urgencias de pediatría. Son pacientes de 11-15 años, sin diferencias en cuanto al sexo. Se objetivó un pico asistencial al final de la tarde e inicio de la noche, los lunes y en los meses de enero y febrero. El diagnóstico más común fue el trastorno de conducta. Destaca la altísima tasa de hospitalización de estos pacientes, más de seis veces superior a la tasa general del servicio de urgencias de nuestro hospital

Introduction In the last few years, a marked increase in the number of psychiatric emergencies treated at pediatric emergency departments has been observed. The aim of the present study was to characterize these patients. Patients and methods We performed a descriptive, prospective, cross sectional study, based on all psychiatric emergencies treated at the pediatric emergency department of Hospital General Universitario Gregorio Marañón, Madrid, from 1-10-04 to 31-3-05. The following variables were analyzed: age, sex, time of consultation, day of the week, day of the month, month of the year, psychiatric antecedents, previous psychiatric pharmacologic treatment, the person or service who took the child to hospital, diagnosis, and whether the patient was admitted to the hospital. Results Of a total of 36,449 emergencies, 79 were psychiatric (0.21 %). Sex rates were 48.1 % boys and 51.9 % girls. The mean (62 SD) age was 13.73 6 2.5 years. Visits were most frequent on Mondays (19 %), in the evening, and in January and February. A total of 13.23 % of the patients were brought by extrahospital services. The main diagnoses were: behavioral disorders (36.76 %), anxiety disorders (20.58 %) and suicidal ideation or suicide attempt (13.23 %). There was a clear male predominance in behavioral disorders (67.85 %) and a female predominance in anxiety disorders (71.42 %) and suicidal ideation or suicide attempt (76.92 %). The hospitalization rate among these patients was 32.35 %. Conclusions The incidence of psychiatric disorders in our pediatric emergency department was low. The patients were aged 11-15 years old, without differences between the sexes. Peak demand was reached on Mondays in January and February, at the end of the evening and beginning of the night. The most common diagnosis was behavioral disorder. The hospitalization rate was exceptionally high, more than 6 times higher than the average in our hospital