Azithromycin and moxifloxacin resistance determinants in Mycoplasma genitalium in Lleida, Spain.

OBJECTIVE: Mycoplasma genitalium (MG) is a microorganism related to sexually transmitted infections. Antibiotic resistance of MG leads to an increase in treatment failure rates and the persistence of the infection. The aim of this study was to describe the most frequent mutations associated with azithromycin and moxifloxacin resistance in our geographical area. METHODS: A prospective study from May 2019 to May 2023 was performed. MG-positive samples were collected. Real-time PCRs (AllplexTM MG-AziR Assay and AllplexTM MG-MoxiR Assay, Seegene) were performed in MG positive samples to detect mutations in 23S rRNA V domain and parC gene. RESULTS: A 37.1% of samples presented resistance determinants to azithromycin and the most common mutation detected was A2059G (57.9%). Resistance to moxifloxacin was studied in 72 azithromycin-resistant samples and 36.1% showed mutations, being G248T the most prevalent (73.1%). CONCLUSIONS: The resistance to different lines of treat ment suggests the need for a targeted therapy and the performing of a test of cure afterwards.

Efficacy of sacral transcutaneous electrical nerve stimulation in patients with overactive bladder refractory to anticholinergic treatment: a prospective multi-center study. / Eficacia de la electroestimulación transcutánea sacra en pacientes con vejiga hiperactiva refractarios a fármacos anticolinérgicos. Estudio prospectivo y multicéntrico.

OBJECTIVE: To determine whether sacral transcutaneous electrical nerve stimulation (S-TENS) is an effective treatment in patients refractory to anticholinergic drugs (Achs). MATERIALS AND METHODS: A prospective multi-center study of patients with overactive bladder (OB) refractory to Achs treated with S-TENS from 2018 to 2021 was carried out. S-TENS was applied over 3 months. Symptom progression was assessed using the voiding calendar and the Pediatric Lower Urinary Tract Symptoms Score (PLUTSS), excluding questions 3 and 4 -referring to enuresis- so that progression of daytime symptoms only (LUTS variable) was analyzed. RESULTS: 66 patients -50% of whom were female- were included, with a mean age of 9.5 years (range: 5-15). S-TENS significantly lowered PLUTSS (19.1 baseline vs. 9.5 final, p< 0.001) and LUTS (13.1 baseline vs. 4.8 final, p< 0.001). It also reduced the number of mictions (8.5 baseline vs. 6.4 final, p< 0.001), while increasing urine volume in the voiding records (214 ml baseline vs. 258 ml final, p< 0.001). Enuresis was the only variable refractory to S-TENS. Complication rate was 3% (2 patients with dermatitis in the S-TENS application area). CONCLUSIONS: S-TENS is effective and safe in the short-term in patients with OB refractory to Achs. Further studies assessing long-term efficacy and potential relapses are required.

OBJETIVOS: Determinar si la electroterapia nerviosa transcutánea a nivel sacro (TENS-S) es un tratamiento efectivo en pacientes refractarios a fármacos anticolinérgicos (Ach). MATERIAL Y METODOS: Estudio prospectivo y multicéntrico: pacientes con VH refractaria a Ach tratados con TENS-S entre 2018-2021. El TENS-S se aplicó durante 3 meses. La evolución sintomática fue evaluada utilizando el calendario miccional y el cuestionario PLUTSS (Pediatric Lower Urinary Tract Symptoms Score), pero excluyendo sus preguntas 3 y 4 (referidas a la enuresis) para analizar solamente la evolución de la sintomatología diurna (variable LUTS). RESULTADOS: Fueron incluidos 66 pacientes (50% niñas), con una edad media de 9,5 años (rango: 5-15). El TENS-S disminuyó significativamente el PLUTSS (19,1 inicial vs 9,5 final, p< 0,001) y el LUTS (13,1 inicial vs 4,8 final, p< 0,001). Además, redujo el número de micciones (8,5 inicial vs 6,4 final, p< 0,001) y aumentó el volumen de orina en los registros miccionales (214 ml inicial vs 258 ml final, p< 0,001). La enuresis fue la única variable refractaria al TENS-S. La tasa de complicaciones fue del 3% (2 pacientes, dermatitis en el área de aplicación del TENS-S). CONCLUSIONES: El TENS-S es efectivo y seguro a corto plazo en pacientes con VH refractarios a los Ach. Deben realizarse estudios para evaluar la eficacia a largo plazo y posibles recaídas.

[Update on vesical electrostimulation and neuropatic bladder in pediatrics: A sistematic review]. / Puesta al día en electroestimulación vesical y vejiga neurógena en pediatría: una revisión sistemática.

INTRODUCTION AND OBJECTIVE: Bladder neuromodulation has emerged as a new alternative in the management of adults with bladder dysfunctions from a neuropathic origin. Despite the fact that, numerous studies have proven the efficacy and safety of this therapy in adults' patients, there are however, still few studies that demonstrate its success in paediatric neuropathic bladder. MATERIALS AND METHODS: We perform a systematic review of the studies which analysed the impact of bladder electrostimulation in paediatric patients (0 to 18 years) with a neurogenic origin. The search identified 9716 potentially articles. Finally, 11 papers published between 1992 and 2019 fulfilled the necessary criteria to be part of our study and were selected for the systematic review. RESULTS: We did not find a common trend among the results obtained from the studies included in the present review. Most of the studies demonstrated an optimal efficacy rate and high safety, but however the superiority of this therapy over anticholinergic drugs could not be established due the presented results. For this fact, these results continue to be controversial. Furthermore, the methodology between the different studies was very huge, which made it difficult to compare the results obtained from each one of them. CONCLUSIONS: Given the potential risk of renal failure presented by paediatric patients with neurogenic bladder, the therapeutic alternatives used in the management of this disease must have a proven efficacy. For this reason, and after the review, due the absence of evidence regarding bladder electrotherapy in this group of patients, its use should be limited and exceptional. Bladder neuromodulation has emerged as a new alternative in the management of adult patients with bladder dysfunctions of neuropathic origin. Despite the fact that numerous studies have proven the efficacy and safety of this therapy in this age group, there are still few studies that show its success in paediatric neuropathic bladder.

TITLE: Puesta al día en electroestimulación vesical y vejiga neurógena en pediatría: una revisión sistemática.Introducción y objetivo. La electroestimulación vesical ha surgido como nueva alternativa en el manejo de pacientes adultos con disfunciones vesicales de origen neuropático. A pesar de que numerosos trabajos han probado la eficacia y la seguridad de esta terapia en este grupo de edad, todavía son escasos los estudios que demuestran su éxito en la vejiga neuropática pediátrica. Material y métodos. Realizamos una revisión sistemática de los estudios que evalúan el impacto de la electroestimulación vesical en pacientes pediátricos (0-18 años) con vejiga de origen neurógeno. La búsqueda identificó 9.716 artículos potencialmente elegibles. Finalmente, 11 trabajos publicados entre 1992 y 2019 cumplieron los criterios necesarios para formar parte del estudio y fueron seleccionados para la presente revisión sistemática. Resultados. No encontramos una tendencia común entre los resultados obtenidos de los estudios incluidos en la presente revisión. A pesar de que la mayoría de ellos demostró individualmente una tasa de eficacia óptima y una alta seguridad, la superioridad de esta terapia frente a los fármacos anticolinérgicos no pudo establecerse. Por tanto, hasta la fecha, sus resultados continúan siendo controvertidos. Además, la metodología entre los diferentes estudios fue muy diversa, lo que dificultó la comparación entre los resultados obtenidos de cada uno de ellos. Conclusiones. Dado el potencial riesgo de insuficiencia renal que presentan los pacientes pediátricos con vejiga neurógena, las alternativas terapéuticas utilizadas en su manejo deben tener una eficacia demostrada. Así, ante la ausencia de evidencia con respecto a la electroestimulación vesical en este grupo de pacientes, por el momento su utilización debería ser limitada y excepcional.

Improved anaerobic digestion of swine manure by simultaneous ammonia recovery using gas-permeable membranes.

In feedstocks containing high ammonia (NH3) concentration, removal of the NH3 during the anaerobic digestion (AD) process can improve AD process performance. In the present study, the effect of NH3 removal using gas-permeable membrane (GPM) technology on AD process performance and biogas production was investigated using swine manure feedstock. Batch and semi-continuous AD experiments were carried out under mesophilic conditions. In the reactor with NH3 recovery, total ammonia nitrogen (TAN) concentration was reduced 28% in batch experiments and 23% on average in the semicontinuous experiment compared with the reactor without NH3 recovery. Free ammonia (FA) concentrations were also decreased by 23% and 4% on average in batch and semicontinuous experiments, respectively. These reductions in TAN and FA by GPM system positively impacted both the quality and quantity of the biogas produced by AD of swine manure. Specifically, the specific methane yield increased 9% in the batch experiment and 17% on average in the semicontinuous experiment. Furthermore, higher percentages of methane in biogas were obtained during AD retrofitted with GPM system, 24% increase in the batch experiment and 11% on average in the semicontinuous experiment (range 8.3-13.6%). Simultaneously, a uniform TAN recovery rate of 6.7 g N TAN per m2 of membrane and per day was obtained for the 205 days of semicontinuous operation; ammonia nitrogen was recovered in the form of ammonium sulphate solution. Therefore, the AD-GPM configuration produces beneficial results on biogas quantity and quality while recovering ammonia nitrogen in form of ammonium sulphate.

[Sacral electrical neurostimulation in the refractory pediatric overactive bladder].

Urinary incontinence is one of the principal reasons for visiting the urologist amongst paediatric patients, and an overactive bladder is the vesical dysfunction that most frequently provokes this. Currently the only medicine approved for managing an overactive bladder is oxybutynin; however, many patients respond partially to this therapy or are refractory to it. Vesical electrotherapy has emerged as a new alternative in the algorithm for managing patients with an overactive bladder refractory to anticholinergic medicines, but the evidence on this issue has to date been scant. We present the case of a 12-year-old patient with an overactive bladder refractory to oxybutynin and solifenacin who presented a good response to treatment with sacral vesical electrotherapy, with complete disappearance of the symptoms (diurnal incontinence and urgency of micturition) without adverse effects.

Quantitative analysis of p16 methylation in Barrett's carcinogenesis.

p16 hypermethylation in Barrett's carcinogenesis has been evaluated in studies which did not take into account sample heterogeneity and yielded qualitative (methylated/unmethylated) instead of accurate quantitative (percentage of CpG methylation) data. We aimed to measure the degree of p16 methylation in pure samples representing all the steps of Barrett's tumorogenesis and to evaluate the influence of sample heterogeneity in methylation analysis. METHODS: 77 paraffin-embedded human esophageal samples were analyzed. Histological grading was established by two pathologists in: negative for dysplasia, indefinite for dysplasia, low-grade dysplasia, high-grade dysplasia and adenocarcinoma. Areas of interest were selected by laser-capture microdissection. p16 methylation was quantified by pyrosequencing. An adjacent section of the whole sample was also analyzed to compare methylation data. RESULTS: After microdissection, we obtained 15 samples of squamous epithelium, 36 non-dysplastic Barrett's esophagus, 3 indefinite for dysplasia, 24 low-grade dysplasia, 4 high-grade dysplasia and 12 adenocarcinoma. Squamous epithelium showed the lowest methylation rates: 6% (IQR 5-11) vs. 11%(7-39.50) in negative/indefinite for dysplasia, p<0.01; 10.60%(6-24) in low-grade dysplasia, p<0.05; and 44.50%(9-66.75) in high-grade dysplasia/adenocarcinoma, p<0.01. This latter group also exhibited higher methylation rates than Barrett's epithelium with and without low-grade dysplasia (p<0.05). p16 methylation rates of microdissected and non-microdissected samples did not correlate unless the considered histological alteration comprised >71% of the sample. CONCLUSIONS: p16 methylation is an early event in Barrett's carcinogenesis which increases with the severity of histological alteration. p16 methylation rates are profoundly influenced by sample heterogeneity, so selection of samples is crucial in order to detect differences.

Predictors of a positive oral food challenge to cow's milk in children sensitized to cow's milk.

INTRODUCTION AND OBJECTIVES: The diagnosis of IgE-mediated cow's milk allergy (CMA) is often based on clinical history and on specific IgE levels and/or skin-prick tests (SPT), both of which are sensitive but not specific. The gold standard, oral food challenge (OFC), is expensive and time-consuming and involves a risk of severe allergic reactions. This study aimed to determine the value of specific IgEs, ratios of specific IgEs for cow's milk and its components to total IgE, and wheal size on SPT for predicting a positive OFC for CMA. MATERIAL AND METHODS: We retrospectively studied 72 patients [median age, four years; age range 0.75-15 years] sensitized to cow's milk who underwent OFCs to milk. predictive variables between patients with positive and negative OFCs were compared. Receiver operator characteristic (ROC) curves were uses to assess variables' discriminatory capacity and Youden's index to determine the best cut-offs for predicting CMA. RESULTS: The OFC was positive in 39 (54%) patients. Wheal size on SPT and all specific IgEs and specific-to-total IgE ratios were significantly different between patients with positive OFCs and those with negative OFCs (p<0.001). The variable with the greatest area under the ROC curve was casein-specific IgE (0.98), followed by ß-lactoglobulin-specific IgE (0.923), casein-specific-to-total-IgE ratio (0.919), and α-lactalbumin-specific IgE (0.908). Casein-specific IgE ≥0.95kU/L yielded 88.9% sensitivity and 90.9% specificity. CONCLUSIONS: In our center, casein-specific IgE >0.95kU/L can obviate an OFC to cow's milk for the diagnosis of CMA in patients sensitized to cow's milk with a compatible history.

At-home transcutaneous electrical nerve stimulation: a therapeutic alternative in the management of pediatric overactive bladder syndrome. / Influencia del sobrepeso y obesidad infantil en la apendicitis aguda en niños. Estudio de cohortes.

INTRODUCTION: In recent years, bladder electroneurostimulation or TENS (Transcutaneous Electrical Nerve Stimulation) has emerged as a new alternative in the management of lower urinary tract dysfunctions. Our objective was to evaluate the efficacy and safety of this therapy in children with overactive bladder. MATERIAL AND METHODS: Prospective study of patients diagnosed with overactive bladder and treated with electroneurostimulation. The system was maintained for 6 months. The severity of urinary symptoms was assessed using the PLUTSS (Pediatric Lower Urinary Tract Scoring System) questionnaire. RESULTS: A total of 21 patients were included in the study, with an average age of 10 years (range: 6-16). The most frequent symptoms were incontinence (89%) and urgency (100%). Statistically significant differences (p<0.05) in mean PLUTSS scores between treatment initiation and treatment completion were found: PLUTSS was 17.8 (range: 10-29) at baseline, 7.21 (range: 2-16) at month 3, and 5.6 (range: 3-12) at month 6. The maximum voiding volume of all patients increased after 6 months of treatment. All patients had their quality of life improved at the end of the study. CONCLUSIONS: Home TENS therapy is a safe and effective option in the management of overactive bladder in the pediatric population. However, further randomized studies should be carried out to protocolize and clarify the effectiveness of this therapeutic approach.

INTRODUCCION: La electroneuroestimulación vesical o TENS (transcutaneous electrical nerve stimulation) ha surgido como nueva alternativa en el manejo de las disfunciones del tracto urinario inferior. Nuestro objetivo fue evaluar la eficacia y seguridad de esta terapia en niños con diagnóstico de vejiga hiperactiva. MATERIAL Y METODOS: Estudio prospectivo de pacientes con diagnóstico de vejiga hiperactiva tratados con electroneuroestimulación. La terapia con TENS domiciliario se mantuvo durante 6 meses. Evaluamos la severidad de la sintomatología urinaria utilizando el cuestionario PLUTSS (Pediatric Lower Urinary Tract Symptoms Score). RESULTADOS: Un total de 21 pacientes (13 niñas) fueron incluidos en el estudio, con una edad media de 10 años (Rango: 6-16). Los síntomas más frecuentes fueron: incontinencia (89%) y urgencia (100%). Encontramos diferencias estadísticamente significativas (p<0,05) en los valores medios del PLUTSS antes de iniciar tratamiento y al finalizar el mismo: PLUTSS inicial 17,8 (Rango: 10-29), a los 3 meses: 7,21 (Rango: 2-16), a los 6 meses: 5,6 (Rango: 3-12). El volumen miccional máximo de todos los pacientes aumentó a los 6 meses de tratamiento. Todos los pacientes sintieron una mejora en su calidad de vida al finalizar el estudio. CONCLUSIONES: La terapia con TENS domiciliario parece una opción segura y eficaz en el manejo de la vejiga hiperactiva, sin embargo, deben ser realizados más estudios randomizados para demostrar su efectividad y protocolizar su aplicación en los pacientes en edad pediátrica.

[Video-assisted thoracoscopic treatment for two ports for idiopathic palmar and axillary hyperhidrosis in children]. / Tratamiento videotoracoscópico por dos puertos para la hiperhidrosis palmar y axilar idiopática en el niño.

JUSTIFICATION: Primary hyperhidrosis is a benign disease that consists in the excessive production of sweat, mainly in the hands, axillas and feet. It may to interfere with the social and work life of the sufferer. It affects up to 3% of the population. In Cuba there are no epidemiological studies on its prevalence. One of the treatment modalities is videothoracoscopic sympathicotomy. OBJECTIVES: To describe the results of the videothoracoscopic sympathicotomy technique for two ports using apneic oxygenation to achieve lung collapse. METHOD: Descriptive, retrospective study of 27 cases operated by primary hyperhidrosis in the period from May 2015 to June 2018. Demographic and clinical characteristics of operated patients, results of the endoscopic surgical technique, postoperative complications and satisfaction were described. RESULTS: The 27 patients were adolescents with ages ranging from 11 to 19 years old, it was more frequent in the female sex. All patients had total solution of the symptoms in the intraoperative period, demonstrated by the cessation of sweat in the palms or axillas and by the verification of the increase of the palmar temperature in the monitor. No patient had intraoperative complications. Compensatory sweating occurred in four patients and one had intercostal neuritis. 100% of the patients were satisfied with the result at 30 days of treatment. CONCLUSIONS: It is a safe technique, with few complications, high satisfaction with the results and feasible to perform in pediatric hospitals with basic resources of minimal access surgery.

FUNDAMENTACION: La hiperhidrosis primaria es una enfermedad benigna que consiste en la excesiva producción de sudor, principalmente en manos, axilas y pies, y por ello puede llegar a condicionar la vida social y laboral de quien la padece. Afecta hasta el 3% de la población. En Cuba no hay estudios epidemiológicos sobre su prevalencia. Una de las modalidades de tratamiento es la simpaticotomía videotoracoscópica. OBJETIVOS: Describir los resultados de la técnica de simpaticotomía videotoracoscópica por dos puertos usando oxigenación apneica para lograr el colapso pulmonar. METODO: Estudio descriptivo, retrospectivo, de una serie de 27 casos operados por hiperhidrosis primaria en el periodo de mayo de 2015 a junio de 2018. Se describen características demográficas y clínicas de pacientes operados, resultados de la técnica quirúrgica endoscópica, complicaciones postoperatorias y satisfacción. RESULTADOS: Los 27 pacientes eran adolescentes con edades comprendidas entre 11 y 19 años, siendo más frecuente en el sexo femenino. Todos los pacientes tuvieron solución total de los síntomas en el periodo intraoperatorio, demostrados por el cese del sudor en palmas o axilas y por la comprobación del aumento de la temperatura palmar en el monitor. Ningún paciente tuvo complicaciones intraoperatorias. El sudor compensatorio se presentó en cuatro pacientes y un paciente tuvo neuritis intercostal. El 100% de los pacientes estuvieron satisfechos con el resultado a los 30 días del tratamiento. CONCLUSIONES: Es una técnica segura, con pocas complicaciones, elevada satisfacción con los resultados y factible de realizar en hospitales pediátricos con recursos básicos de cirugía de mínimo acceso.

[Varicoceles in adolescents and relationship with bmi: are varicoceles more frequent in tall thin men?] / Varicoceles en adolescentes y su relación con el índice de masa corporal: ¿son más frecuentes en varones altos y delgados?

OBJECTIVES: Varicocele is a dilatation of the venous pampiniform plexus considered the leading cause of correctible male infertility. Varicocele ethology remains controversial and there have been several studies which inform that varicoceles are found less frequently in obese adolescents but relationship between varicocele and body mass index (BMI) remains controversial yet. SUBJECTS AND METHODS: To study the relationship between varicocele and body mass index in children population we review the patients treated for varicocele in our institution. We analyzed patients with varicocele surgical correction in our centre in the last 10 years. At our institution all patients were treated by Palomo technique. We analyzed: age, location and degree of varicocele, weight and height, surgical technique, appearance of reactive hydrocele or others complications, varicocele recurrence and reoperation. Our objective is to study the relationship between BMI and varicocele in adolescent boys. RESULTS: We observed that varicocele in our series was found more frequently in taller patients and less frequently in obese patients (higher BMI). CONCLUSIONS: Future studies will be needed to confirm that theory and to understand varicocele ethology but we consider that this fact is very useful because we are talking about a pathology with repercussion in fertility so we must be alert about it in adolescent population to correct it.

OBJETIVOS: El varicocele constituye la principal causa de infertilidad masculina tratable. Su fisiopatología no es todavía bien conocida y existen varios estudios que sugieren que esta patología se desarrolla con menos frecuencia en pacientes obesos. Sin embargo, la relación entre el varicocele y el índice de masa corporal (IMC) continúa siendo controvertida. Nuestro objetivo es estudiar los pacientes pediátricos con varicocele y establecer una relación entre el IMC de estos pacientes y esta patología. MATERIAL Y METODOS: Para estudiar la relación entre el varicocele y el índice de masa corporal en la población infantil, revisamos a los pacientes intervenidos de varicocele en nuestro centro. Se estudiaron 79 pacientes en los últimos 10 años. Todos los pacientes fueron tratados con técnica de Palomo. Analizamos: edad, localización y grado de varicocele, peso y talla, técnica quirúrgica, aparición de hidrocele reactivo u otras complicaciones, recurrencia de varicocele y reintervención. RESULTADOS: Observamos en nuestra serie una mayor frecuencia de varicocele en pacientes más altos y delgados (menor IMC) comparándolos con los pacientes con mayor masa corporal en relación a la altura. CONCLUSIONES: Concluimos que según nuestra serie y en concordancia con literatura, el varicocele podría darse con más frecuencia en pacientes altos y delgados. Son necesarios más estudios para confirmar este hecho y aclarar la fisiopatología de esta entidad, pero dado que se trata de una patología que podría tener repercusión en la fertilidad creemos que debemos estar alerta en este grupo de pacientes para detectar esta patología y valorar la necesidad de corrección.

[Urinary incontinence and lower urinary tract dysfunction prevalence in schoolchildren: risk factors]. / Prevalencia de incontinencia urinaria diurna (IUD), disfunción del tracto urinario inferior en edad escolar y análisis de factores de riesgo.

Recently, many papers report an increase of pediatric lower urinary tract dysfunction (LUTD), which affects 10-15% of schoolchildren. Recent life style and dietary changes have been postulated as the cause of that high prevalence. There is a lack in epidemiological investigations about bowel and bladder dysfunctions and the risk factors. We aim to know the LUTD prevalence and the main risk factors. We carry out an observational and transversal investigation with a representative sample of our pediatric schoolchildren (N=1,069). We used a questionnaire about toilet training habits, social, familiar, and dietary data. We also used the PLUTSS (Pediatric Lower Urinary Tract Symptoms Score) questionnaire after validation of the Spanish version. The logistic regression analysis determined the main risk factors of DTUI. Results showed that boys get toilet trained later than girls (2.41 vs. 2.25) and the rate of incontinence is greater than girls when they start on the school. 31.9% of children remove their diapers to get into school. The prevalence was 15% for diurnal urinary incontinence and 12.2% nocturnal, DTUI 8.3%, constipation 20%, faecal incontinence 2.8%, ITUs 12.4%, retention habits 39.8%. 28.7% of children with DTUI refer psychological affectation. The main independent predictors were: male sex (OR 1.87), younger children (OR 0.78), forced toilet training (OR 2.14), constipation (OR 1.61) and holding habits (OR=3.87). This study showed a high prevalence of bladder in our pediatric population. Male gender, voiding postposition, early schooling or constipation were the main risk factors. The knowledge of the bladder and bowel dysfunction prevalence and the toilet training habits in our Community lets us to conclude school, family and primary care recommendations. This will let to prevent this so much prevalent disease.

En los últimos años se ha incrementado la prevalencia de disfunciones del tracto urinario inferior (DTUI), afectando al 10-15% de escolares. Este incremento se ha relacionado con cambios en el estilo de vida y dietéticos. Pocos estudios analizan los factores de riesgo. Nuestro objetivo es conocer la prevalencia de DTUI y sus principales factores. Realizamos un estudio observacional transversal de prevalencia sobre una muestra representativa de escolares de nuestra comunidad (N=1.069). Utilizamos un cuestionario sobre hábitos de aprendizaje miccional, hábito intestinal y datos dietéticos. Asociamos el cuestionario PLUTSS (Pediatric Lower Urinary Tract Symptoms Score) de screening de DTUI, tras traducirlo y validarlo en español. Análisis de regresión logística evaluaron los principales factores de riesgo. Los varones retiran el pañal más tarde (2,41 vs. 2,25) comenzando el colegio con mayor porcentaje de incontinencia. El 31,9% retiraron el pañal para poder escolarizarse. La prevalencia de incontinencia urinaria fue 15% diurna y 12,2% nocturna, la de DTUI 8,3%, estreñimiento 20%, incontinencia fecal 2,8%, ITUs 12,4%, hábito posponedor 39,8%. El 28,7% de las DTUI referían repercusión psicológica. Los principales factores de riesgo fueron: varón (OR 1,87), menor edad (OR 0,78), retirada de pañal forzada por escolarización (OR 2,14), estreñimiento (OR 1,61) y hábito retencionista (OR 3,87). Nuestro estudio mostró una elevada prevalencia de disfunción vesical en nuestra población pediátrica. El sexo masculino, el hábito posponedor, la escolarización precoz y el estreñimiento fueron los principales factores de riesgo. Conocer su epidemiología, nos ha permitido emitir recomendaciones escolares, familiares y en atención primaria, con el fin de prevenir esta patología tan prevalente.

[DRESS syndrome, a differencial diagnosis in late postoperative complications]. / Síndrome de DRESS en el diagnóstico diferencial de las complicaciones postquirúrgicas.

The DRESS syndrome (drug rash with eosinophilia and systemic symptoms) is a serious pharmacodermia which must be taken into account when establishing an optimal early treatment to prevent a systemic and potentially lethal evolution. Pharmacodermias are the third most frequent cause of adverse effects during surgical hospitalization, after nosocomial infections and intraoperative complications. In most cases, they pose a challenge to the surgeon, since their onset is nonspecific and, therefore, can be easily mistaken for a surgery complication. We present the case of a 54-year-old man, healthy and without relevant background, who was operated on two times due to spontaneous abdominal bleeding. Three weeks after the last surgery, and coinciding with the administration of oral metamizole, the patient developed a DRESS syndrome. The initial unspecific deterioration, characteristic of this syndrome, is the main cause of the delay in diagnosis and correct treatment, causing the resulting evolution to systemic affectation.

[Parent controled analgesia system in postoperative pain management in patients undergoing lip and cleft palate surgery]. / Analgesia mediante bomba de infusión continua controlada por el paciente para el manejo postoperatorio del dolor en pacientes intervenidos de fisura palatina y labio fisurado.

OBJECTIVES: Craniofacial clefts surgery associates a painful postoperative pain whose management is complicated with conventional analgesia. PATIENTS AND METHODS: A parent controlled analgesia system was implanted with a continuous perfusion of tramadol, ondansetron and metamizole adjusted by weight. Parents are allowed to administer additional boluses if they observe irritability. We compared the variables of the cleft patients operated before and after the implantation of the system in our center. RESULTS: During 2016, 16 craniofacial clefts were operated (4 cheilorhinoplasties and 12 palatal clefts). No PCA (parent controlled analgesia) system was used. The average time of stay in PICU was 1.5 days. It took an average of 2.5 days to initiate tolerance. The mean of VAS (Visual Analogic Scale) was 3. 53% required major opioids (morphine, fentanyl) not being sufficient analgesia every 3 hours. During 2017, 7 palatal fissures and 4 cheilorhinoplasties were operated (11). Both of them were controlled by PCA. Patients with palatal cleft were admitted to the PICU with a total mean of 0.5 days. The beginning of tolerance was advanced to the first postoperative day. The VAS diminished to 0.5. Only one patient required opioids. 72% did not need to associate any type of analgesia. CONCLUSIONS: The PCA system is a safe and risk-free insurance for analgesia of fissured patients with benefits such as: decrease in pain, stay in PICU, the need for analgesia and initiation of early tolerance.

OBJETIVOS: La cirugía de las fisuras craneofaciales asocia un intenso dolor postoperatorio cuyo manejo resulta complicado con la analgesia convencional. MATERIAL Y METODOS: Utilizamos una bomba de analgesia controlada por los padres que contiene una perfusión continua de tramadol, ondansetrón y metamizol ajustada por peso. Se permite a los padres administrar bolos adicionales si observan irritabilidad. Comparamos variables de los pacientes fisurados intervenidos antes y después de la implantación del sistema en nuestro centro. RESULTADOS: Durante 2016 fueron intervenidos 16 fisurados (4 queilorrinoplastias y 12 fisuras palatinas). En ninguno se empleó bomba de analgesia. El tiempo medio de estancia en UCIP fue 1,5 días. Tardaron de media 2,5 días en iniciar tolerancia. La media de EVA (Escala Analógica Visual) fue de 3. El 53% precisaron opiáceos mayores (morfina, fentanilo), no siendo suficiente la analgesia c/3 horas. Durante 2017 se operaron 7 fisuras palatinas y 4 queilorrinoplastias (11). En todos empleamos bomba. Únicamente ingresaron en UCIP las fisuras palatinas (debido al manejo de la vía aérea) con una media total de 0,5 días. Se adelantó el inicio de tolerancia al primer día postoperatorio. La EVA disminuyo a 0,5. Solo un paciente precisó opiáceos. El 72% no precisó asociar ningún tipo de analgesia. CONCLUSIONES: La bomba de PCA (analgesia controlada por el paciente/por los padres) es un método seguro y exento de riesgo para la analgesia de los pacientes fisurados con beneficios como: disminución del dolor, de la estancia en UCIP, de la necesidad de analgesia e inicio de tolerancia precoz.