Individual and social factors associated with active commuting to school in 4-6 years old Spanish children.

To examine the prevalence of active commuting to school (ACS) in 4 to 6 year old children and individual and social factors associated with it. Cross-sectional study including 1,159 children from Cuenca and Ciudad Real (Castilla-La Mancha, Spain). ACS, population area, and socioeconomic status (SES) were self-reported by parents. Body mass index and cardiorespiratory fitness (CRF) were measured using standard procedures. Binary logistic regression models were used to assess the strength of association between the mode of commuting (ACS/no-ACS) and individual (weight status and CRF) and social (population area and SES) factors. Forty-six percent of the children ACS. The probability of ACS was greater in boys and girls from families of low/medium-low SES and in girls who lived in urban areas. ACS was not associated with weight status and CRF. Effective interventions need to be promoted, especially in children from families of high SES and those living in rural areas.

Oral Immunotherapy With Egg and Milk: Changes in Peripheral Serum Cytokines Are Not Predictive Factors for Severe Adverse Reactions or for the Final Report.

BACKGROUND: Oral immunotherapy (OIT) is a new approach in patients with food allergy. Various immunological mechanisms underlie the reversal of food allergy. In this paper, we study possible changes in peripheral cytokine patterns during OIT. METHODS: Determinations of cytokines in peripheral blood were made in children who had milk or egg allergy and who received OIT. The determinations were made before and after OIT, and again following a final repeat oral challenge a month after a diet excluding the culprit food. RESULTS: No significant changes were registered in the cytokines studied (IL-2, IL-4, IL-6, IL-10, IL-12, IL-17, IFNγ, and TNF) at any of the 3 time points. Similarly, no differences in cytokine pattern were observed between children who had presented anaphylaxis during OIT and those who overcame or did not overcome the final oral challenge. DISCUSSION: Peripheral cytokines do not undergo significant changes during the OIT process. They are not predictors of serious adverse reactions or the final result of the OIT.

Absceso retroperitoneal secundario a espondilodiscitis tuberculosa simulando una hernia inguinal incarcerada.

Tuberculosis is the commonest cause of spinal infection worldwide (9-46%). Tuberculosis spondylodiscitis causes multifocal thoracic and lumbar spinal disease, and big paraspinal and psoas abscesses. It is more frequent in people under 40 who had previous tuberculosis infection and from countries where the illness is endemic. Clinic is non-specific and sub-acute. We report the clinical case of a 29-year-old patient who suffered from pericardic tuberculosis in her childhood and who presents a bilateral retroperitoneal abscess due to tuberculosis spondylodiscitis. Her clinical debut began with left inguinal pain and an irreducible mass at this level that simulated an incarcerated inguinal hernia, which is why surgery was indicated. Due to discrepancies between intraoperative findings and the initial diagnosis, the diagnosis and treatment strategy were changed. The purpose of this case report is to emphasize the challenge that the diagnosis of this pathology represents, due to low incidence in our environment and poor clinical features, which results in late diagnosis and late management.

[Buschke-Lowenstein Tumor associated to nasopharyngeal condillomatosis]. / Tumor de Buschke-Lowenstein asociado a condilomatosis nasofaríngea.

Giant Acuminata Condyloma or Buschke-Lowenstein Tumor (BLT) is a rare disease characterized typically by its perineal location, local aggressiveness and its cauliflower-like aspect. BLT is associated with Human Papilloma Virus (HPV) infection. Because malignant transformation of BLT is high, radical local excision and histopathological examination are needed. We report a 26-year-old male, seropositive for HIV with giant verrucous lesions in the inguinal, perineal, suprapubic and genital area. Rectosismoidoscopy revealed anal canal involvement. Oropharyngeal papillomatosis was also found. Wide local excision was performed, including inguinoperineal and oropharyngeal lesions. Pathology studies show papillomatosis with koilocytes and no evidence of malignant transformation.

Psoas abscess due to Pasteurella multocida.

Psoas abscess is a pus collection within the muscle compartment. It is a very uncommon entity. It can be primary as a result of haematogenous spread or secondary as a consequence of a direct extension of an infectious focus. Diagnosis is usually delayed because nonspecific clinical presentation. Staphylococcus aureus is the most common organism cultured in this type of abscess. We describe a secondary psoas abscess in an elderly female patient. The patient presented with fever, right groin pain and malaise. Following laboratory, radiological and microbiological analyses the patient was diagnosed as having a psoas abscess due to Pasteurella multocida, which is a Gram negative bacteria, part of the normal oral flora of many animals and can causes human infections after animal scratches or bites. More rarely is to find this organism causing psoas abscesses. Because of insidious clinical presentation, the diagnosis of psoas abscess is a challenge and a high index of suspicion is required. We emphasize the importance of bacteriological confirmation of microorganism involved to choose the correct antibiotics. Percutaneous drainage is the treatment of choice. Open surgical drainage should be reserved if percutaneous drainage fails.

Spigelian hernia. Personal experience and review of the literature.

OBJECTIVE: Spigelian hernia is an uncommon abdominal wall defect. We present our series of patients with Spigelian hernia and a literature review. PATIENTS: We carried out a retrospective review of patients operated on from 2001 to 2008. Epidemiological aspects, diagnostic methods, surgical technique characteristics, morbidity, hospital stay, recurrences and follow up are analyzed. RESULTS: We have treated 39 patients, 25 female and 14 male, with a mean age of 70 years. Left side was the most frequent location. Risk factors were present in 74% of patients. Diagnosis was made clinically in 72% of cases. Open hernioplasty followed by laparoscopic hernioplasty are the most frequent techniques performed. Emergency operation was needed in 20% of patients. Postoperative morbidity is very low. CONCLUSIONS: Diagnosis of Spigelian hernia is basically clinic. The gold standard is TC in doubtful cases. An important percentage of patients will present with an acute complication of the Spigelian hernia as their first symptom. Surgical technique depends on patient characteristics, type of hernia and surgeon experience.

[Epidemiological characteristics and risk factors for apparent life-threatening events]. / Características epidemiológicas y factores de riesgo de los episodios aparentemente letales.

INTRODUCTION: To report our experience with a guideline approach for the assessment of apparent life-threatening events (ALTE) in our pediatric emergency departments (PED), to know their incidence, epidemiological characteristics and the yield of laboratory investigations (LI). PATIENTS AND METHODS: Prospective, case-control study of a guideline approach for infants under age 12 months who suffered an ALTE between 01/06/06 and 31/05/07 and were attended at our PEDs. We ordered LI as a function of the clinical history. All the cases were admitted for a minimum of 12h. We conducted a telephone interview at 12 months. RESULTS: Fifty ALTE were included, corresponding to an incidence of 5 per thousand live births. The median age was 8.46+/-8.7 weeks. Compared to controls they had significantly more primogenits and previous behavioral abnormalities. Only 13 presented significant abnormalities at examination, and 6 had recurrent ALTE at the PED. LI were abnormal in 41 (82%), but only in 8 cases did they contribute to a secondary diagnosis. There were 29 idiopathic ALTE (58%). Twenty one (42%) had associated conditions, who had smoked significantly more during pregnancy, age older than 12 weeks and abnormalities at examination. Four had recurrence of the episodes: one suffered a sudden infant death syndrome (SIDS). At 12 months the cases had a significantly higher incidence of recurrent vomiting, breath holding spells and weight-psychomotor retardation. CONCLUSIONS: The ALTE incidence was 5 per thousand live births. Primogenits and/or behavioral abnormalities were most frequent during the first weeks after birth and/or thereafter at 12 months of age. A total of 42% had a related diagnosis: associated with age older than 12 weeks, maternal smoking habits and abnormalities at examination. There was one case of SIDS. Laboratory investigations had a low yield.

Histological and Immunohistochemical Evaluation of the Efficacy of a New Cosmetic Formulation in the Treatment of Skin Photoaging.

Objective. Mechanism of action of cosmetic products is not often studied. The aim of this study is to determine the histological, immunohistochemical, and clinical changes of a new cosmetic formulation. Methods. Prospective, single-blind, patient-controlled, randomized study in 10 volunteers with mild to moderate skin photoaging on the back of their hands. The product was applied on one hand and a standard cream on the other hand, twice a day for three months. Standardized photographs were taken on basal (T0) and final visit (T1) and skin biopsies were performed. Changes on histological and immunohistochemical markers were studied. Subjective clinical changes were determined. Results. After treatment, a 26.3% improvement on epidermal thickness was detected and a significant increase on collagens I and III, elastin, and fibronectin fibers was achieved (p < 0.05). As the expression of MMPs remained stable, this improvement of dermal matrix was attributed to the stimulation of their synthesis. A significant clinical improvement on the treated hand was obtained, compared to control hand. Conclusion. This new cosmetic product with combination of three registered technologies (IFC-CAF, WGC, and RetinSphere), focused on regenerating dermal matrix and activating proliferation of skin cells, has shown to be efficient in the reversion of skin photoaging.

Oral immunotherapy with egg and milk: changes in peripheral serum cytokines are not predictive factors for severe adverse reactions or for the final report

Introduction: Oral immunotherapy (OIT) is a new approach in patients with food allergy. Various immunological mechanisms underlie the reversal of food allergy. In this paper, we study possible changes in peripheral cytokine patterns during OIT. Methods: Determinations of cytokines in peripheral blood were made in children who had milk or egg allergy and who received OIT. The determinations were made before and after OIT, and again following a final repeat oral challenge a month after a diet excluding the culprit food. Results: No significant changes were registered in the cytokines studied (IL-2, IL-4, IL-6, IL-10, IL-12, IL-17, IFNγ, and TNF) at any of the 3 time points. Similarly, no differences in cytokine pattern were observed between children who had presented anaphylaxis during OIT and those who overcame or did not overcome the final oral challenge. Discussion: Peripheral cytokines do not undergo significant changes during the OIT process. They are not predictors of serious adverse reactions or the final result of the OIT (AU)

Introducción: Se ha introducido la inmunoterapia oral frente a alimentos como una nueva terapia en pacientes con alergia alimentaria. Diferentes mecanismos inmunológicos han sido descritos en un intento de explicar la reversibilidad de esta situación de alergia alimentaria. En este artículo, estudiamos los posibles cambios en el patrón de citoquinas en sangre periférica a lo largo del proceso de la inmunoterapia oral. Métodos: Se realizó determinación de citokinas en sangre periférica en tantos niños con alergia a leche o huevo que realizaron inmunoterapia oral. Las determinaciones se realizaron tanto de forma previa como tras la finalización de la OIT, así como tras una reprovocación final, un mes después de seguir una dieta exenta del alimento implicado. Resultados: No se registraron cambios significativos en las citokinas estudiadas (IL-2, IL-4, IL-6, IL-10, IL-12, IL-17, IFNγ y TNF) entre ninguna de las tres determinaciones temporales. Tampoco existieron diferencias en el patrón de citokinas entre los niños que habían presentado anafilaxias durante la OIT ni entre los que superaron o no superaron la provocación final. Discusión: Las citokinas periféricas no sufren cambios significativos a lo largo del proceso de OIT. No son factores predictivos de reacciones adversas graves ni del resultado final de la OIT (AU)

Sección de Urgencias de Pediatría y Cuidados Intensivos pediátricos: Atención infantil integral ambulatoria y atención al paciente crítico / Pediatric Emergency and Pediatric Intensive Care Section: Comprehensive outpatient child care and critical patient care

El documento presenta la situación de la Sección de Urgencias-Cuidados Intensivos Pediátricos (CIP). Tras una introducción que pretende enmarcar la sección en su contexto histórico y demográfico, se describe la misión, visión, valores y la cartera de servicios de la sección. Posteriormente se detalla la actividad asistencial, la labor docente y los proyectos y líneas de investigación. Para finalizar, se explica brevemente nuestro compromiso con la calidad y seguridad del paciente y nuestras líneas estratégicas para la integración con atención primaria (AU)

The paper presents the status of the Section of Emergency-CIP. Alter an introductory section aims to frame the historical and demographic background, mission, vision, values and the range 01 services described in section. Subsequently those services, the teaching and research projects and detailed lines. To conclude briefly describes our commitment to quality and patient safety and lar our strategic integration lines with primary care (AU)

Hernias de Spiegel. Nuestra experiencia y revisión de la literatura / Spigelian hernia. Personal experience and review of the literature

Objetivo: la hernia de Spiegel es una variedad poco frecuente de defecto de la pared abdominal. Presentamos nuestra serie de pacientes intervenidos con éste diagnóstico, así como una revisión de la literatura. Pacientes: se realiza un estudio retrospectivo de los pacientes intervenidos por hernia de Spiegel en nuestro centro entre los años 2001 y 2008. Se analizan factores epidemiológicos, forma de diagnóstico, características de la técnica quirúrgica, morbilidad, estancia hospitalaria, recidivas y seguimiento. Resultados: han sido intervenidos 39 pacientes, 25 mujeres y 14 hombres, con una edad media de 70 años. La localización más frecuente es la izquierda. El 74% de los pacientes presenta 1 o más factores de riesgo. El diagnóstico fue clínico en el 72% de los casos. La técnica más empleada es la hernioplastia seguida de la hernioplastia laparoscópica y en el 20% de los casos la intervención tuvo que realizarse de forma urgente. La morbilidad postoperatoria es escasa. Conclusiones: el diagnóstico de la hernia de Spiegel es fundamentalmente clínico. En caso de duda diagnóstica el TAC es la prueba de elección. En un porcentaje importante de pacientes la primera manifestación es la incarceración. La técnica quirúrgica dependerá de las características del paciente, la hernia y la experiencia del cirujano(AU)

Objective: Spigelian hernia is an uncommon abdominal wall defect. We present our series of patients with Spigelian hernia and a literature review. Patients: we carried out a retrospective review of patients operated on from 2001 to 2008. Epidemiological aspects, diagnostic methods, surgical technique characteristics, morbidity, hospital stay, recurrences and follow up are analyzed. Results: we have treated 39 patients, 25 female and 14 male, with a mean age of 70 years. Left side was the most frequent location. Risk factors were present in 74% of patients. Diagnosis was made clinically in 72% of cases. Open hernioplasty followed by laparoscopic hernioplasty are the most frequent techniques performed. Emergency operation was needed in 20% of patients. Postoperative morbidity is very low. Conclusions: diagnosis of Spigelian hernia is basically clinic. The gold standard is TC in doubtful cases. An important percentage of patients will present with an acute complication of the Spigelian hernia as their first symptom. Surgical technique depends on patient characteristics, type of hernia and surgeon experience(AU)

Regulation of D-fructose transporter GLUT5 in the ileum of spontaneously hypertensive rats.

Abnormalities in carbohydrate metabolism and the insulin resistance status have been associated with hypertension. We have previously described alterations in the sodium-coupled sugar absorption in an experimental model of hypertension; in the present work, we studied the regulation of the sodium-independent, GLUT5-facilitated D-fructose intestinal transport in this pathology. Spontaneously hypertensive rats (SHR) and their normotensive, genetic control Wistar-Kyoto (WKY) rats, were used. Kinetic studies, carried out in ileal brush-border membrane vesicles (BBMVs), revealed a significant reduction (P < 0.05) in the maximal rate of transport (Vmax) for D-fructose in SHR, which, on the other hand, showed unaltered values for the Michaelis constant (Km) and the diffusion constant (Kd). Immunoblotting analysis revealed the existence of lower (P< 0.05) levels of GLUT5 in apical membranes from SHR, this reduction being similar to that of Vmax. Similarly, Northern blot studies on the abundance of GLUT5 mRNA from ileal enterocytes showed a decrease (P< 0.05) in hypertensive rats, following the same pattern mentioned above. Therefore, the impaired D-fructose intestinal absorption is another feature of SHR, and this decrease in D-fructose uptake correlates with a reduction in the abundance of the apical GLUT5 transporter, which is controlled at a transcriptional level.

[Vertical transmission of hepatitis B]. / Hepatitis B de transmisión vertical.

Five cases of perinatal HBV infections of vertical transmission (mother-child) are reported. The authors comments the most important clinical and epidemiological characteristics of this way of transmission in paediatrics patients and emphasized the interest that has the screening in pregnant women. Finally, the guide-lines of neonatal prophylaxis recommended is described.

Características epidemiológicas y factores de riesgo de los episodios aparentemente letales / Epidemiological characteristics and risk factors for apparent life-threatening events

Introducción: Aportar nuestra experiencia en la aplicación de un protocolo en nuestro servicio de urgencias de pediatría (SUP) en los episodios aparentemente letales (EAL), conocer su incidencia, su perfil epidemiológico y el rendimiento de las pruebas complementarias (PC) realizadas. Pacientes y métodos: Estudio prospectivo de casos y controles, de aplicación de un protocolo a lactantes menores de 12 meses que acudieron del 01/06/06 al 31/05/07 con historia de EAL. Se realizaron distintas PC en función de la clínica e historia. Todos ingresaron un mínimo de 12h. Se realizó una entrevista telefónica a los 12 meses. Resultados: Se seleccionaron 50 casos con una incidencia de 5 por cada 1.000 recién nacidos (RN) vivos. La edad fue de 8,46±8,7 semanas. Respecto a los controles hubo significativamente más primogénitos y con antecedentes de alteración del comportamiento. La exploración fue anormal en 13 y 6 presentaron recurrencia en el SUP. Cuarenta y uno (82%) tuvieron alterada alguna PC, pero sólo en 8 contribuyeron al diagnóstico. Veintinueve (58%) fueron idiopáticos y 21 (42%) fueron secundarios. Éstos tuvieron de forma significativa mayor incidencia de tabaquismo materno, edad>12 semanas y exploración alterada. Cuatro recidivaron las semanas posteriores, y uno presentó el síndrome de muerte súbita del lactante (SMSL). A los 12 meses, los casos tuvieron de forma significativa mayor incidencia de vómitos recurrentes, espasmos del sollozo, retraso psicomotor y pondoestatural. Conclusiones: La incidencia fue del 5‰ RN vivos. Fueron más frecuentemente primogénitos o presentaron anomalías en el comportamiento las semanas previas o a los 12 meses. El 42% tuvo un diagnóstico secundario que se asoció a edad >12 semanas, tabaquismo materno y exploración alterada en el SUP. Una lactante presentó un SMSL. Las PC realizadas en el SUP tuvieron un escaso rendimiento (AU)

Introduction: To report our experience with a guideline approach for the assessment of apparent life-threatening events (ALTE) in our pediatric emergency departments (PED), to know their incidence, epidemiological characteristics and the yield of laboratory investigations (LI). Patients and methods: Prospective, case-control study of a guideline approach for infants under age 12 months who suffered an ALTE between 01/06/06 and 31/05/07 and were attended at our PEDs. We ordered LI as a function of the clinical history. All the cases were admitted for a minimum of 12h. We conducted a telephone interview at 12 months. Results: Fifty ALTE were included, corresponding to an incidence of 5‰ live births. The median age was 8.46±8.7 weeks. Compared to controls they had significantly more primogenits and previous behavioral abnormalities. Only 13 presented significant abnormalities at examination, and 6 had recurrent ALTE at the PED. LI were abnormal in 41 (82%), but only in 8 cases did they contribute to a secondary diagnosis. There were 29 idiopathic ALTE (58%). Twenty one (42%) had associated conditions, who had smoked significantly more during pregnancy, age older than 12 weeks and abnormalities at examination. Four had recurrence of the episodes: one suffered a sudden infant death syndrome (SIDS). At 12 months the cases had a significantly higher incidence of recurrent vomiting, breath holding spells and weight-psychomotor retardation. Conclusions: The ALTE incidence was 5‰ live births. Primogenits and/or behavioral abnormalities were most frequent during the first weeks after birth and/or thereafter at 12 months of age. A total of 42% had a related diagnosis: associated with age older than 12 weeks, maternal smoking habits and abnormalities at examination. There was one case of SIDS. Laboratory investigations had a low yield (AU)

Tratamiento del hallux valgus mediante osteotomía en scarf / Treatment of hallux valgus by scarf osteotomy

Objetivo: Evaluar los resultados clínicos y radiográficos de la osteotomía en scarf para el tratamiento del hallux valgus moderado-severo. Material y métodos: Estudio retrospectivo con 25 osteotomías en «scarf», en 19 pacientes mujeres y 6 hombres, siendo la edad media de 45 años y un seguimiento medio de 11 meses, para el tratamiento del hallux valgus moderado y grave. Se realizó una valoración clínica pre y postoperatoria con la escala funcional de la American Orthopaedic Foot and Ankle Society (AOFAS) y una valoración radiográfica, mediante la medición de los ángulos intermetatarsiano (IMA), de hallux valgus (HVA) y distal de la articulación metatarso-falángica (DMAA), también de forma pre y postoperatoria. Resultados: La estancia media de ingreso fue de 1 día. Según la escala AOFAS, se obtuvo una puntuación global preoperatoria de 34,4 y postoperatoria de 92,4. Los resultados radiográficos postoperatorios fueron un IMA medio de 8,8º y un HVA medio de 18,2º. El DMAA fue menor de 10º, excepto en 1 paciente. Conclusión: La osteotomía en scarf ofrece al paciente un apoyo temprano, una movilidad metatarso-falángica precoz y una rápida consolidación de la osteotomía (AU)

Objective: To assess the clinical and radiographic results of the scarf osteotomy in the treatment of moderatesevere hallux valgus. Patients and methods: We performed a retrospective study of 25 scarf, in 19 women and 6 men, with average age of 45 years and an average follow up of 11 months for the treatment of the moderate-severe hallux valgus. We assessed the clinical outcome pre and posoperative according to the American Orthopaedic Foot and Ankle Society (AOFAS) scale and radiological outcome, with measuring the angles intermetatarsal (IMA), of hallux valgus (HVA) and distal of metatarsal-phalang joint (DMAA), pre and postoperative. Results: The average stay of revenue was one day. According to the AOFAS scale, we obtained a global preoperative score of 34.4 and postoperative of 92.4. About the postoperative radiological findings, we obtained an average IMA of 8.8 º and HVA of 18.2 º. The DMAA was less than 10º except in 1 patient. Conclusion: The scarf osteotomy offers an early load, an early metatarsal-phalang joint mobility and an early osteotomy consolidation (AU)