Transition of Adolescents With Severe Asthma From Pediatric to Adult Care in Spain: The STAR Consensus.

OBJECTIVES: To assess the degree of consensus among a multidisciplinary expert panel on the transition of adolescents with severe asthma from pediatric to adult care. METHODS: A 61-item survey was developed based on guidelines for other chronic diseases, covering transition planning, preparation, effective transfer, and follow-up. A 2-round Delphi process assessed the degree of consensus among 98 experts (49 pediatricians, 24 allergists, and 25 pulmonologists). Consensus was established with ≥70% agreement. RESULTS: Consensus was reached for 42 items (70%). Panelists were unable to agree on an age range for initiation of transition. The main goal during the transition identified by the experts is for adolescents to gain autonomy in managing severe asthma and prescribed treatments. The panelists agreed on the importance of developing an individualized plan, promoting patient autonomy, and identifying factors associated with the home environment. They agreed that the adult health care team should have expertise in severe asthma, biologics, and management of adolescent patients. Pediatric and adult health care teams should share clinical information, agree on the criteria for maintaining biological therapy, and have an on-site joint visit with the patient before the effective transfer. Adult health care professionals should closely follow the patient after the effective transfer to ensure correct inhaler technique, adherence, and attendance at health care appointments. CONCLUSION: This consensus document provides the first roadmap for Spanish pediatric and adult teams to ensure that key aspects of the transition process in severe asthma are covered. The implementation of these recommendations will improve the quality of care offered to the patient.

[Hypersensitivity reactions to non-steroidal anti-inflammatory drugs and tolerance to alternative drugs]. / Reacciones de hipersensibilidad a antiinflamatorios no esteroideos y su tolerancia a fármacos alternativos.

INTRODUCTION: Hypersensitivity reactions to non-steroidal anti-inflammatory drugs (NSAIDs) are the most common reactions to drugs. The prevalence varies from 0.6 to 5.7% in general population, but there are no data available in children. The aim of this study is to determine the frequency of patients diagnosed with hypersensitivity to NSAIDs, and describe their clinical characteristics, type of hypersensitivity, and tolerance to alternative drugs. METHODS: Retrospective study was conducted on children with suspected hypersensitivity to NSAIDs from January 2012 to December 2013. The diagnosis was confirmed by oral drug provocation test (DPT) to the drug involved in the group with a history of one episode, while in the group with a history of more than one episode with the same drug the diagnosis was based on clinical data. Subsequently, a DPT with acetylsalicylic acid (ASA) was done in order to classify hypersensitivity into selective or multiple. In those cases with a positive result, a DPT was performed with alternative drugs. RESULTS: Out of a total of 93 children studied, 26 were diagnosed with hypersensitivity to NSAIDs: 7 confirmed by oral DPT, and 19 based on clinical data. Multiple hypersensitivity was diagnosed in 50% of patients. Ibuprofen was involved in all reactions. The most common clinical manifestation was angioedema (44%). Acetaminophen was the best tolerated alternative drug. CONCLUSIONS: More than one quarter (28%) of the population studied was diagnosed with hypersensitivity to NSAIDs, and 50% had multiple hypersensitivity. Acetaminophen is a safe alternative in children with hypersensitivity to NSAIDs. Meloxicam may be an alternative in cases that do not tolerate acetaminophen.

A 10% liquid immunoglobulin preparation for intravenous use (Privigen®) in paediatric patients with primary immunodeficiencies and hypersensitivity to IVIG.

BACKGROUND: The objective of this study was to evaluate safety and efficacy of Privigen®, a 10% intravenous immunoglobulin (IVIG), in a particular group of paediatric patients (highly sensitive to previous IVIG infusion) affected with Primary Immunodeficiencies (PID). MATERIAL AND METHODS: Patients (n=8) from 3 to 17 years old diagnosed of PID who often suffered from adverse events related to the infusion to previous IVIG were switched to Privigen® in an open protocol. Data were prospectively collected regarding Privigen® administration: infusion, safety and efficacy. In parallel, data on safety and tolerance were retrospectively collected from medical charts regarding the previous 10% IVIG product used. RESULTS: 50% of the patients required premedication with previous IVIG. At the end of the study none required premedication with Privigen®. The infusion rate was lower than that recommended by the manufacturer. All patients had suffered through adverse events during previous IVIG infusion being severe in three patients and recurrent in the rest. With Privigen® only three patients suffered from an adverse event (all cases were milder than previous related). Trough levels of IgG remained stable. None suffer from any episode of bacterial infection. CONCLUSION: The present work shows that Privigen® was safe in a group of hypersensitive paediatric patients who did not tolerate the administration of a previous 10% liquid IVIG by using a particular infusion protocol slower than recommended. The number of adverse effects was smaller than published, and all cases were mild. No premedication was needed. Privigen® was also effective in this small group.

[Treatment of the dysfunction of the pelvic floor]. / Tratamiento de la disfunción del suelo pélvico.

The perineum is formed by muscle-aponeurotic elements that are integrated under the control of the nervous system. Their alterations are responsible for urogynecological, coloproctologic and sexual pathologies. In order to obtain a successful treatment, it is obliged not to forget the role that plays the perineum in those pathologies. The treatment of the dysfunction of the pelvic floor groups conservative techniques and procedures like changes in life habits, behavioural therapy, biofeedback, electroestimulation (neuromodulation and peripheral electrical stimulation) and training with muscular exercises of the pelvic floor (perineal rehabilitation). The objective of all of them is to improve or to obtain the urinary continence, the strengthening of its musculature to be able to balance pelvic static, to improve the local vascularization and the anorrectal function besides securing a satisfactory sexuality.

[Perinatal outcomes in immigrant women]. / Resultados perinatales de las gestantes inmigrantes.

OBJECTIVES: To describe the characteristics of immigrant women's newborns in our environment, and to compare them with those of native women's newborns. PATIENTS AND METHODS: All newborns attended in the Neonatology Section of Hospital del Mar in Barcelona, Spain, in 2003 and 2004 were included (n 5 2,735). Data were prospectively collected in a database. Pregnant immigrant women were classified in 6 regions (Eastern Europe, the rest of Europe, Africa, Asia, Latin America and other countries). Twelve diagnoses were defined and compared between native newborns and those of immigrant parents, and their relative risks were calculated. RESULTS: There were 1,296 native newborns (47.8 %) and 1,416 of immigrant origin (52.2 %). Immigrant women showed a higher rate of HBsAg carrier status (2.0 % versus 1.0 %) and a lower rate of hepatitis C virus infection (0.8 % vs 2.0 %; p < 0.01). There was only one HIV-positive pregnant immigrant woman compared with 14 Spanish women (p < 0.01), and drug use was lower in the immigrant group (0.4 % vs 4.0 %; p < 0.01). Immigrant newborns had a lower rate of prematurity (6.0 % vs 7.6 %) and of low birthweight (2.3 % vs 4.6 %; p < 0.01). There were no significant differences in the rate of respiratory distress or fetal acidosis. The incidence of neonatal infection risk was higher in immigrant newborns (49.9 % vs 40.6 %; p < 0.01). CONCLUSIONS: In our environment, immigrant mothers' newborns have better perinatal outcomes than native newborns. The most frequent complications are secondary to an inadequate.

[Spontaneous passage of a submandibular salivary stone]. / Expulsión espontánea de un cálculo salival submandibular.

Sialolithiasis rarely occurs in children and usually affects the submandibular salivary gland. Because of its rarity, its clinical expression is frequently missed and diagnosis is delayed. We describe the case of a 9-year-old boy with submandibular sialolithiasis who presented spontaneous passage of a large salivary stone. We review the clinical findings and etiopathogenesis of sialolithiasis in children, as well as diagnostic imaging techniques and several therapeutic approaches to stone extraction.