Infección urinaria: lo que el pediatra debería conocer / Urinary tract infection: what the pediatrician should know

La infección urinaria es una de las patologías más frecuentes en pediatría. En algunos casos puede producir daño renal, llevando al paciente a hipertensión arterial e insuficiencia renal. En esta revisión se enfatiza el oportuno reconocimiento de los síntomas, la necesidad de diagnosticar la infección urinaria de acuerdo al resultado del examen de orina y cultivo, utilizando el apropiado método de recolección de orina. También se preconiza el correcto tratamiento de acuerdo a la localización de la infección. Finalmente comentamos acerca del tratamiento y profilaxis en los pacientes portadores de reflujo vésico ureteral.

Urinary tract infections (UTIs) are very common in children, and may lead to renal scarring, hypertension, and renal failure. In this review, we emphasize the prompt recognition of symptoms, the need to diagnose UTI according to bacterial colony count on urine culture from sample collected using proper methodology, and the available treatment options according to localization of site of infection in the urinary tract. New approaches on the use of antibiotic prophylaxis inpatients with vesicoureteral reflux are presented.

Tratamiento de las glomerulopatías más frecuentes en pediatría: lesión mínima y glomeruloesclerosis focal y segmentada / g

En niños, las enfermedades glomerulares son frecuentes y algunas participan activamente engrosando las estadísticas de insuficiencia renal crónica. Dentro de ellas, las más frecuentes son el síndrome nefrótico con lesión mínima, generalmente de buen pronóstico. Y, aunque no frecuente pero habitualmente de mal pronóstico, las glomeruloesclerosis focal y segmentaria. Existen otras glomerulopatías pero que en general no constituyen un problema dada su baja frecuencia en la población pediátrica. Respecto de su etiología, no son totalmente conocidas, aunque muchas veces responden a trastornos inmunológicos y de allí que los tratamientos estén basados en drogas inmunosupresoras. Se han utilizado múltiples medicamentos con resultados en muchos casos dudosos en cuanto a producir mejoría. Los de mayor uso son los corticoides, inhibidores de calcineurina, citotóxicos, agentes antiproliferativos y los inmunomoduladores. De acuerdo a los conocimientos actuales, se hace una revisión de los tratamientos con los respectivos resultados para las dos patologías más frecuentes en pediatría, el síndrome nefrótico con lesión mínima y la glomeruloesclerosis focal segmentaria.

Paediatric case-mix of the Lorraine regional database in 1994 and 1995.

In the region, there is a need to predict the necessary number of paediatric beds. Paediatric discharge data from the 1994-95 Lorraine regional database of Anonymous Discharge Summaries (ADS) are used for this study. We analyse the concentration and specialisation of the hospital activity types and we estimate the numbers of paediatric beds needed for the year 2,000. For the same percentage of the case-mix by hospital group, concentration of the activity is more important in the small District General Hospital (DGH) than in the Teaching Hospital (TH). In the most important Medical Diagnosis Categories (MDC), the case-mix variation by age class can't be characterised inside of the MDC group. The different methods we use to estimate the need of paediatric beds, give similar estimations for the year 2,000.

Differences of case-mix according to the type of hospital: methodological aspects and results.

This study has brought to the fore variations of case-mix according to the type of French hospitals taken into consideration. The GHM line-up in the French classification of the hospital stays (French DRG) have also been studied and variations linked to the type of hospitals have been noticed too. This survey has been carried out thanks to the anonymous discharge summary issued by the national and the regional databases.

Legionella jordanis pneumonia unresponsive to fluoroquinolones in a non-immunocompromised host.

Legionella jordanis has seldom been reported as a cause of infection in humans. We describe a case of pneumonia due to L. jordanis that occurred in a non-immunocompromised 74-year-old patient and failed to respond to a combination of ceftriaxone and ofloxacin. Cure was achieved only after an erythromycin-rifampin combination was started.

Case mix of elderly in-patients in the 29 hospitals in Lorraine in 1994 and 1995.

The creation of regional standardized medical information databases in relation with the French anonymous discharge dataset allows the study of the geriatric case mix processed in the Lorraine region for patients over 69. The age histogram (69 to 107 years) presents a two mode distribution with an important dip centered on 79 years probably in connection with the demography of Lorraine and the consequences of the First World War. These geriatric patients represent 17% of hospitalisations in public and private hospitals participating in the public sector. The case mix is related to the size of the hospital and to its juridical status. The bigger the size of an hospital, the less its activity is concentrated on a small number of disorders. Lung and heart diseases represent the first cause of hospitalisation in all hospitals. It is necessary to underline the limitation of an approach which uses the patients' individual hospitalisations, and which does not allow different stays of a given patient on the same hospital or between different hospitals to be linked. This approach prevents from appreciating the care network for this elderly population suffering from chronic diseases.