[Acute osteomyelitis: epidemiology, clinical manifestations, diagnosis and treatment]. / Osteomielitis aguda: epidemiología, manifestaciones clínicas, diagnóstico y tratamiento.

BACKGROUND AND AIMS: The present study focuses on the epidemiology, clinical and laboratory data, and management of osteomyelitis in a pediatric third level hospital. METHODOLOGY: All cases of children under 15 years-old admitted with osteomyelitis between 2000 and 2011 were retrospectively reviewed until July 2006, then prospectively from then until 2011. RESULTS: A total of 50 patients were identified (52% males) with median age at diagnosis of 2 years. Principal onset manifestations were pain (94%), functional impairment (90%) and fever (72%). The femur (32%), fibula (28%) and calcaneus (22%) were most affected bones. Leucocytosis > 12.000/µl was found in 56%, elevated ESR > 20 mm/h in 26%, and elevated CRP > 20 mg/L in 64%. Blood culture was positive in 20%, with group A streptococcus being the most frequently isolated bacteria (11%). All diagnoses were confirmed by a (99)Tc scintigraphy bone scan. Antibiotic therapy was initially intravenously (mean time of administration: 10 days ± 3 SD), followed by oral medication (mean time of administration: 18 days ± 6 SD). Surgery was necessary in 3 patients. Evolution of all cases was excellent, despite 3 exceptions that resolved over time. CONCLUSIONS: The current short-term intravenous therapy led to shorter hospitalizations. There were no statistically significant differences between time from clinical onset or in CRP levels at discharge compared to long-term therapies prior to 2006.

[Kawasaki disease: Diagnosis and treatment]. / Enfermedad de Kawasaki: diagnóstico y tratamiento.

INTRODUCTION: Kawasaki disease is the leading cause of acquired heart disease in children. In spite of the efficacy of intravenous immunoglobulin (IGIV), the absence of a specific diagnostic test and due to there being IGIV-refractory patients, Kawasaki disease is a major cause of coronary artery abnormalities (CAA). OBJECTIVES: To analyze the clinical and epidemiological characteristics of cases of Kawasaki disease, to evaluate the efficacy of treatments used and the CAA observed. METHODS: We retrospectively reviewed the medical records of children diagnosed with Kawasaki disease between January 2002 and December 2008 in a tertiary public Hospital in the South of Madrid. The diagnosis of Kawasaki disease was based on the clinical criteria proposed by the American Academy of Pediatrics in 2004. RESULTS: Twenty three children were identified. Median age was 26 months (range: 2 months-10 years). Nineteen children (82%) were younger than 5 years old. Fever and changes in the lips and oral cavity were present in all cases. Twenty-one patients (91%) received IGIV, all of them before the 10th day of disease. One child (4.7%) required the administration of more than one dose of IGIV, because persistence of fever. CAA was recorded in three patients [13.0%, (95% CI: 1-26%)], including a four month-old boy. All patients with CAA were treated with the recommended dose of IGIV, 2g/kg, between the 5th and 8th day of disease. CONCLUSIONS: Kawasaki disease was more common in children less than five years old. We observed a high rate of CAA in children with Kawasaki disease in spite of appropriate and timely treatment.

[Malaria in the South of Madrid: a clinical and epidemiological review]. / Revisión de los casos de paludismo de los últimos 12 años en el Hospital Universitario de Getafe.

INTRODUCTION: Malaria has increased in Spain, and is potentially severe in children. Information on pediatric malaria in Spain is scarce. The aim is to evaluate the clinical, therapeutic and epidemiological characteristics of children diagnosed with malaria in our hospital. PATIENTS AND METHODS: A retrospective descriptive study was performed on all pediatric cases of malaria diagnosed in Getafe University Hospital, from January 1995 to November 2006. Epidemiological and clinical features, as well as diagnostic methods, treatments and outcome were studied. An analysis of two comparative periods (before and after January 2000) was carried out. RESULTS: Eighteen cases of confirmed malaria were identified, twelve girls and six boys. The age range was from 13 months to 13 years with a median age of 60 months. All patients had recently travelled to or from endemic countries. Despite having a stable number of admissions to hospital over time, all but two patients were diagnosed in the second period (P<0.01). Fever and gastrointestinal symptoms were the most common symptoms, with liver or spleen enlargement in 75%. Thrombocytopenia and anemia were common. No cases of complicated malaria or death occurred. Plasmodium identification by microscopic examination was used in all cases. Identification of Plasmodium species with PCR was carried out in 16 children. P. falciparum was found in 89% of these cases. Quinine-sulphate and clindamycin were used in 72%. CONCLUSIONS: The incidence of pediatric malaria is increasing in the southern area of Madrid, with P. falciparum as the most frequently identified species. Microscopic visualization or identification of its antigen are gold-standard diagnostic methods, however, identification with PCR is essential upon admission to determine the species and discard possible multiple infestations. Pediatricians must learn to suspect this potentially severe disease, in order to establish an early treatment that may improve the prognosis.

[Physical exercise and food habits: a study of adolescents in Cádiz]. / Ejercicio físico y hábitos alimentarios: un estudio en adolescentes de Cádiz.

BACKGROUND: A increased number of eating disorders among teen-agers are currently being reported. Physical exercise, especially when done individually, is one of the methods chosen for losing weight. We are basing this study on the hypothesis of a larger number of eating habit disorders (EHD's) in subjects who do physical exercise alone. This study describes and compares eating habits among teen-agers that do individual exercise as opposed to athletes who work out in groups or on teams. METHOD: Cross-section study of 532 teen-agers ages 14-18 who are enrolled in school and who do physical exercise, having been selected at random by means of a two-stage, stratified sampling process. The subjects were divided into two groups according whether they did individual physical exercise alone (Number: 216) or in groups (Number: 316). The eating habits of both groups were analyzed based on a questionnaire filled out by the subjects themselves. RESULTS: In the group preferring individual sports, females were predominant (degree of males 0.44). Of these females, their being on diets in order to lose weight was 3.12 times more frequent, compulsive eating episodes being 3.73 times more frequent. As regards behaviors which might be considered to be compensatory, there is a clear concentration thereof among those who do sports individually, hence 43% stated to voluntarily undergo periods of fasting (4.96 times more than those who exercise in groups), 46% stating to have brought on vomiting at one time or another for "dieting" purposes (3.76 more) and up to 26% have used laxatives with the intention of losing weight (2.56 times more than among athletes who play on teams). CONCLUSION: The existence of EHD's seems to be associated with teen-agers who play individual sports as opposed to those who play on teams.

[Level of knowledge about nourishment/nutrition among school adolescents in Cadiz]. / Nivel de conocimientos sobre alimentación/nutrición en adolescentes escolarizados de Cádiz.

OBJECTIVE: To determine the level of knowledge about nourishment/nutrition and how this knowledge is distributed among school adolescent population in the town of Cádiz. DESIGN: Descriptive and transversal study. SETTING: Schools. PARTICIPANTS: Sample of 630 subjects from the school adolescent population in the town of Cádiz. MEASUREMENTS AND MAIN RESULTS: The average level of knowledge about nourishment/nutrition is 6.63 (in a 0-13 scale). No significant differences were found according to the perception of proportion or disproportion in height and weight, level of concern about body fats and getting fat, diets, avoiding some food or taking some medication, dietary fibers and infusions or any other weight-reducing products and physical exercise and fitting. The relationship between the level of knowledge and the BMI is very close to statistical significance. CONCLUSIONS: We found a middle level of knowledge about nourishment/nutrition. We think this level of knowledge should be raised and other factors determining healthy habits should be considered. It is necessary to go on with research and contextualize nourishment habits.

[Adolescence and contraception]. / Adolescencia y contracepción.

The birthrate has decreased for all age groups except for adolescents. 4.51% of all pregnancies in Spain fall within the 15-19 year old age group. The prevention of adolescent pregnancy indicates the need for making family planning services more accessible to young people. The object of this study was a review of medical consultations performed in 1993 with adolescents at a family planning service. Among the most significant results are the following: the average age of menarche and coitus primaris was 11.8 years (+ or -2.2 years) and 16 years (+ or -1.7) respectively. The period between coitus primaris and the act of going to a family planning center was 9.1 months (+ or -2.3). 81.7% of those adolescents were advised to take oral contraceptives, 12.4% condoms, 1.96% the I.U.D. and 3.9% none. Among the most common side effects noted after taking oral contraceptives for 6 to 12 months were: psychic alterations (changes of mood, etc.), spotting, digestive upset, migraines and weight increase. The number of sexual partners before and after contraceptive use did not change significantly.

[Contraception in adolescents included in a family planning program]. / Anticoncepción en adolescentes incluidas en un programa de planificación familiar.

OBJECTIVE: To describe the motives of consultation, kinds of contraceptive methods and side-effects of oral contraceptives (OCs) in adolescent users of a family planning program. DESIGN: Family planning program at the District Primary Care Unit, Cádiz, Spain. PATIENTS: 283 adolescent females who requested attendance in a family planning program from January 1993 until January 1994. MEASUREMENTS AND MAIN RESULTS: A medical history of every adolescent was carried out and every patient was examined. Those who were recommended the use of OCs passed through 3 controls: at the beginning, after the 6th month and after 1 year. These controls consisted in recording sexual risk behaviours as well as several analytic tests. RESULTS: Most adolescents requested the prescription of contraceptive methods (81.7% of the most prescribed and demanded methods were OCs). We found no serious side-effects after 1 year, so we can conclude that OCs are an usefull contraceptive choice for sexually active adolescents because of its security, acceptance and easy use.

[Anthropometric assessment of the nutritional status of the adolescent population of Cádiz (Spain)]. / Valoración antropométrica del estado nutricional en una población adolescente de Cádiz.

OBJECTIVE: The results of a series of anthropometrical values of nutritional nature, which were used to determine corporal composition, are presented. PATIENTS AND METHODS: The samples were taken from schools in the city of Cádiz. A total of 945 young people between the ages of 10 and 17 years were used. In each case, tricipital skinfold thickness, Quetelet's index, brachial fat area and brachial adipose muscular quotient were determined. RESULTS: A comparison of the values we obtain with those of national studies showed our figures to be higher. CONCLUSIONS: The figures given for our adolescent population are intended to serve as a reference point for use in nutritional studies in this geographical area.

[The USFAM Study: the prevalence of allergic diseases in the school-age population of the province of Cádiz. I. Ubrique, San Fernando, Algeciras and Medina Sidonia]. / Estudio USFAM: prevalencia de las enfermedades alérgicas en la población escolar de la provincia de Cádiz. Parte I.

The purpose of this study was to determine the prevalence of allergic diseases in the school population of the province of Cádiz in order to confirm the hypothesis that these diseases are more frequent there than in the rest of the Spanish provinces. Four cities of our province were chosen (Ubrique, San Fernando, Algeciras and Medina Sidonia, whose initials form the acrostic USFAM) with clear differential characteristics (climatological, orographical, environmental, etc). In each city, schools, both public and private, were chosen at random. Complete classes were used, and the age-limit was that established in each school. A questionnaire was given to all of the parents who, together with the teachers, were given instructions for its completion. Of the 4,000 questionnaires distributed, 2,572 were correctly completed. Of these, 1,988 answered that their child was non-allergic and 584 as allergic (22.7%). The ratio male/female was almost 2/1 (64.4%/35.6%) and the largest prevalence of these allergic diseases was in the group of children between 10 and 13 years of age. We have found that the prevalence of this pathology in the province of Cádiz is higher than the national mean.

[Evaluation of the Andalusia Vaccination Program in the Sierra de Cádiz Sanitary District]. / Evaluación del Programa de Vacunación de Andalucía (PVA) en el distrito sanitario Sierra de Cádiz.

One of the foundations for good child care is the application of a vaccination program. With this report we evaluate the vaccination coverage (January 1991) of a group of children (1319), born during 1988 between January 1st and October 1st, in the Sierra of the District of Cadiz. Our results show that 87.64% participated in the Vaccination Program. The first vaccination was received by 80.06% of these children. This rate decreased as we advanced through the vaccination calendar, reaching 76.34% for the measles/mumps/rubella vaccination and 66.71% for the vaccination at 2 years of age. Therefore, one-third of this child population did not complete the vaccination schedule. The most frequently found complication was a local reaction, whereas the counter-indication most frequently observed was an acute infectious illness.