Usefulness of virtual reality in the management of pain associated with venepuncture: a multicentre randomized clinical trial.

OBJECTIVE: To assess the efficacy of virtual reality (VR) in reducing pain and anxiety associated with scheduled blood draws. MATERIAL AND METHODS: We conducted multicentre randomized clinical trial in both primary care and hospital settings. The study included children aged 7-12 years undergoing blood extraction procedures between March and October 2022. The intervention group used headsets, and the control group received usual care. Pain was assessed using the visual analogue scale and anxiety using the Groningen Distress Scale. The anxiety of the nursing staff and family satisfaction were assessed with numerical scales ranging from 1 to 10. RESULTS: The study included 83 patients: 40 in the control group and 43 in the VR group. The median age was 10 years (range, 7-12 years). In the VR group, 83.7% of the children reported mild pain, compared to 57.5% in the control group (P = .012). Also, 93% of children in the VR group showed calm or mild anxiety (score, 1-2), compared to 72% of the control group, a difference that was not statistically significant (P = .08). Family satisfaction was higher in the RV group (score ≥ 9/10: 93% of RV group vs 72.5% of control group; P = .026). The nursing staff anxiety score was less than 5 in more than 90% of cases, with no differences between groups (P = .13). CONCLUSION: The use of VR during venepuncture decreases the pain perceived by children and increases the satisfaction of their families.

[Epstein-Barr virus primary infection in healthy children]. / Primoinfección por el virus de Epstein-Barr en niños sanos.

INTRODUCTION: The aim of this study is to assess epidemiological, clinical and laboratory characteristics of primary infection by Epstein-Barr virus (EBV) in children without previous diagnosis of any immune disease and its relationship with clinical presentation. PATIENTS AND METHODS: A retrospective study was conducted on all children from 0 to 15 years with IgM against viral capsid of EBV positive or indeterminate during a 22 month period. Epidemiological, clinical and laboratory data were analysed and compared between typical (mononucleosis syndrome) and non-typical clinical symptoms. RESULTS: The study included a total of 103 children, with a median age of 7 years (3-12.5 years). Almost two-thirds (63%) of patients had typical clinical signs, with a mononucleosis syndrome, and 37% had a non-typical presentation. The non-typical clinical group had a lower age (P=.03) and took less antibiotic than the typical clinical group (P=.015). From laboratory studies, there were no differences between the groups, except in RCP, which was higher in typical clinical group (P=.04). Heterophile antibodies were positive in 33% of patients. An indeterminate IgM against viral capsid was present in 20% of the patients, and most of them had an oligosymptomatic or atypical presentation. An IgM positive for other viruses was found in 21%, and 3 of them were suspicious of false positive for EBV. CONCLUSIONS: In the studied population, a primary infection due to EBV is common in younger ages, and they have usually an oligosymptomatic clinical presentation. A very low percentage of positive heterophile antibodies were found. Cases with indeterminate IgM against viral capsid are more frequent in the non-typical clinical group. Co-infection with other viruses is common.

Utilidad de la realidad virtual en el manejo del dolor asociado a venopunción: ensayo clínico aleatorizado multicéntrico / Usefulness of virtual reality in the management of pain associated with venepuncture: A multicentre randomized clinical trial

Objetivo: Comprobar la eficacia de la realidad virtual (RV) en la disminución del dolor y ansiedad asociados a extracciones sanguíneas programadas. Material y métodos: Ensayo clínico aleatorizado multicéntrico realizado en atención primaria y hospitalaria. Se incluyeron los pacientes de 7 a 12 años que acudieron entre marzo y octubre de 2022 a realizarse una extracción sanguínea programada. En el grupo intervención se utilizaron gafas de RV y en el grupo control cuidados habituales. Se evaluó el dolor mediante la escala visual analógica y la ansiedad mediante la Groningen Distress Scale. Se evaluó la ansiedad de enfermería y la satisfacción de los familiares, mediante escala numérica del 1 al 10. Resultados: Se incluyeron 83 pacientes: 40 en el grupo control y 43 en el grupo RV. La mediana de edad fue de 10 años (rango de 7 a 12); 83,7% de los niños en el grupo RV refirió dolor leve, frente a 57,5% del grupo control (p = 0,012). Del grupo RV, 93% mostró calma o ansiedad leve (puntuación 1-2), frente a 72% del grupo control, aunque sin diferencias estadísticamente significativas (p = 0,08). La satisfacción de los familiares fue mayor en el grupo RV (≥ 9/10: 93% de RV vs. 72,5% de controles, p = 0,026). La ansiedad de enfermería fue < 5 en más del 90% de los casos, sin diferencias entre grupos (p = 0,13). Conclusiones: El uso de RV durante la venopunción disminuye el dolor percibido por los niños y aumenta la satisfacción de sus familiares.(AU)

Objective: To assess the efficacy of virtual reality (VR) in reducing pain and anxiety associated with scheduled blood draws. Material and methods: We conducted multicentre randomized clinical trial in both primary care and hospital settings. The study included children aged 7–12 years undergoing blood extraction procedures between March and October 2022. The intervention group used headsets, and the control group received usual care. Pain was assessed using the visual analogue scale and anxiety using the Groningen Distress Scale. The anxiety of the nursing staff and family satisfaction were assessed with numerical scales ranging from 1 to 10. Results: The study included 83 patients: 40 in the control group and 43 in the VR group. The median age was 10 years (range, 7–12 years). In the VR group, 83.7% of the children reported mild pain, compared to 57.5% in the control group (P = .012). Also, 93% of children in the VR group showed calm or mild anxiety (score, 1–2), compared to 72% of the control group, a difference that was not statistically significant (P = .08). Family satisfaction was higher in the RV group (score ≥ 9/10: 93% of RV group vs. 72.5% of control group; P = .026). The nursing staff anxiety score was less than 5 in more than 90% of cases, with no differences between groups (P = .13). Conclusions: The use of VR during venepuncture decreases the pain perceived by children and increases the satisfaction of their families.(AU)

Hipotonía en un lactante por atrofia muscular espinal / Hypotonia in an infant due to spinal muscular atrophy

La hipotonía en el lactante es un signo inespecífico de la exploración física que puede aparecer en el contexto de múltiples enfermedades. La detección precoz desde Atención Primaria a través de las revisiones de salud es fundamental. Una adecuada historia clínica, junto con una exploración neurológica adaptada a la edad que permita distinguir entre hipotonía central y periférica, van a ser claves en la aproximación diagnóstica inicial. Presentamos el caso de un lactante de un mes de vida con hipotonía. Se confirma el diagnóstico de atrofia muscular espinal, una entidad poco frecuente cuyo pronóstico ha mejorado debido al descubrimiento de nuevas estrategias terapéuticas (AU)

Infant hypotonia is a nonspecific sign on physical examination that may appear in multiple diseases. Early detection from primary care through health reviews is necessary. An adequate clinical history with an age-adapted neurological examination to distinguish between central and peripheral hypotonia, will be key in the initial diagnostic approach. We present the case of a one-month-old infant with hypotonia. The diagnosis of spinal muscular atrophy is confirmed, a rare entity whose prognosis has improved due to (AU)the discovery of new therapeutic strategies.

Lesiones cutáneas diagnósticas de enfermedad sistémica transitoria / Diagnostic skin lesions of transient systemic disease

El lupus neonatal cutáneo es una entidad de buen pronóstico que se resuelve antes del año de vida con el aclaramiento de los anticuerpos maternos. El lupus eritematoso neonatal puede presentar manifestaciones cardiacas (50%), cutáneas (50%) o coexistencia de ambas (10%). Su diagnóstico requiere un alto índice de sospecha, incluyendo una buena historia clínica con antecedentes familiares

Cutaneous neonatal lupus is an entity with good prognosis, it is resolved within the first year of age with the clearance of maternal antibodies. Neonatal lupus erythematosus may present cardiac (50%), cutaneous (50%) or coexistence of both (10%). Its diagnosis requires a high index of suspicion, including a good clinical history with a family history

Primoinfección por el virus de Epstein-Barr en niños sanos / Epstein-Barr virus primary infection in healthy children

Introducción: El objetivo de este estudio es conocer las características epidemiológicas, clínicas y analíticas de la primoinfección por el virus de Epstein-Barr (VEB) en niños sin diagnóstico previo de ninguna enfermedad inmune y su relación con la forma de presentación clínica. Pacientes y métodos: Estudio retrospectivo de pacientes entre 0 y 15 años con IgM sérica frente a la cápside viral del VEB positiva o indeterminada, durante un período de 22 meses. Se analizaron datos epidemiológicos, clínicos y de laboratorio y se compararon según tuvieran una clínica típica (síndrome mononucleósico) o no típica. Resultados: Se incluyeron 103 niños. La mediana de la edad fue de 7 años (3-12,5 años). El 63% de los pacientes presentaron clínica típica o síndrome mononucleósico y el 37% una clínica no típica. La edad fue significativamente menor en el grupo de clínica no típica (p = 0,03) y recibieron menos tratamiento antibiótico (p = 0,015). En los parámetros analíticos no hubo diferencias estadísticamente significativas excepto en la PCR, discretamente más elevada en el grupo de clínica típica (p = 0,04). El 33% de los pacientes tuvieron anticuerpos heterófilos positivos. El 20% tuvieron una IgM frente a la cápside viral indeterminada, la mayoría con clínica oligosintomática o atípica. El 21% tuvieron IgM positivas para otros virus y 3 de ellos fueron posibles falsos positivos para el VEB. Conclusiones: En nuestra población, la primoinfección por VEB es frecuente en niños de menor edad, y en ellos predominan las formas oligosintomáticas. El porcentaje de anticuerpos heterófilos positivos ha sido muy bajo en nuestra muestra. Los casos con IgM frente a la cápside viral indeterminada son más frecuentes en el grupo de clínica no típica. Es común detectar coinfección con otros virus

Introduction: The aim of this study is to assess epidemiological, clinical and laboratory characteristics of primary infection by Epstein-Barr virus (EBV) in children without previous diagnosis of any immune disease and its relationship with clinical presentation. Patients and methods: A retrospective study was conducted on all children from 0 to 15 years with IgM against viral capsid of EBV positive or indeterminate during a 22 month period. Epidemiological, clinical and laboratory data were analysed and compared between typical (mononucleosis syndrome) and non-typical clinical symptoms. Results: The study included a total of 103 children, with a median age of 7 years (3-12.5 years). Almost two-thirds (63%) of patients had typical clinical signs, with a mononucleosis syndrome, and 37% had a non-typical presentation. The non-typical clinical group had a lower age (P = .03) and took less antibiotic than the typical clinical group (P = .015). From laboratory studies, there were no differences between the groups, except in RCP, which was higher in typical clinical group (P = .04). Heterophile antibodies were positive in 33% of patients. An indeterminate IgM against viral capsid was present in 20% of the patients, and most of them had an oligosymptomatic or atypical presentation. An IgM positive for other viruses was found in 21%, and 3 of them were suspicious of false positive for EBV. Conclusions: In the studied population, a primary infection due to EBV is common in younger ages, and they have usually an oligosymptomatic clinical presentation. A very low percentage of positive heterophile antibodies were found. Cases with indeterminate IgM against viral capsid are more frequent in the non-typical clinical group. Co-infection with other viruses is common

Análisis de 37 casos de leishmaniasis en niños, diagnosticados en una comarca de Valencia, España / Analysis of 37 cases of leishmaniasis in children, diagnosed in a region of Valencia, Spain

INTRODUCCIÓN: el objetivo fue analizar el aumento de incidencia de leishmaniasis observado en el Departamento Xàtiva-Ontinyent de la Comunidad Valenciana, España, y establecer un patrón clínico, valorando la forma de presentación, diagnóstico y respuesta al tratamiento. MÉTODOS: estudio epidemiológico retrospectivo en niños menores de 15 años, con diagnóstico de leishmaniasis visceral y cutánea, en el hospital Lluís Alcanyís de Xàtiva, desde enero de 2009 a diciembre de 2018. RESULTADOS: se recogieron 37 casos de leishmaniasis, 15 viscerales y 22 cutáneos. La mediana de edad fue de 17 meses para viscerales y de 2 años y 8 meses para cutáneos. En el momento del diagnóstico de leishmaniasis visceral, todos presentaron fiebre, anemia y esplenomegalia. En la leishmaniasis cutánea se presentaron en forma de placa o pápula eritematosa. Su confirmación diagnóstica se realizó en el 68% de los casos por visualización directa en la biopsia de la lesión de amastigotes, y en el 32% mediante reacción en cadena de la polimerasa (PCR) de frotis o biopsia de piel. En las leishmaniasis viscerales, el aspirado de médula ósea fue positivo en el 25% de los casos y en la PCR en sangre periférica en el 100%. Todas las leishmaniasis viscerales fueron tratadas con anfotericina B liposomal, con desaparición de la fiebre a las 72 horas. El 91% de las leishmaniasis cutáneas fueron tratadas con antimoniato de meglumina, y todas evolucionaron favorablemente. CONCLUSIONES: se confirma el aumento de incidencia de leishmaniasis en los años recogidos y se analiza el perfil clínico de estos pacientes de edad pediátrica, que es diferente al del adulto, y presentan una buena respuesta al tratamiento

INTRODUCTION: the aim of the study was to analyse the increase in the incidence of leishmaniasis observed in the Xativa-Ontinyent health area of the Valencian Community, Spain, and to determine the clinical profile of this disease, analysing the clinical manifestations, diagnosis and response to treatment. METHODS: we conducted a retrospective epidemiological study in children aged less than 15 years given a diagnosis of visceral or cutaneous leishmaniasis at the Hospital Lluís Alcanyís in Xàtiva between January 2009 and December 2018. RESULTS: the study included 37 cases of leishmaniasis, 15 visceral and 22 cutaneous. The median age was 17 months in cases of visceral leishmaniasis and 2 years and 8 months in cases of cutaneous leishmaniasis. At the time of diagnosis, all patients with visceral leishmaniasis presented with fever, anaemia and splenomegaly. Cutaneous leishmaniasis manifested with erythematous papules or plaques. The diagnosis was confirmed by direct visualization of amastigotes in lesion biopsy samples in 68% of cases, and in 32% by PCR of a skin scrape or lesion biopsy. In patients with visceral leishmaniasis, testing of the bone marrow aspirate was positive in 25% and the PCR test of peripheral blood was positive in 100%. All patients with visceral leishmaniasis were treated with liposomal amphotericin B, with resolution of fever within 72 hours. Ninety-one percent of patients with cutaneous leishmaniasis were treated with meglumine antimony, and all had favourable outcomes. CONCLUSIONS: we confirmed the increase in the incidence of leishmaniasis in the years under study and analysed the clinical profile of paediatric cases of leishmaniasis, which differs from the patterns observed in adults, observing a good response to treatment

Rigidez de nuca, ¿siempre neurológico? Pensemos algo más / Stiff neck, is it always neurological? Let's think about something else

Las complicaciones supurativas de la faringoamigdalitis aguda no tratada o inadecuadamente tratada son infrecuentes. Destacan, por su potencial gravedad, el absceso retrofaríngeo y parafaríngeo. Por su presentación clínica como limitación de movilidad cervical o rigidez de nuca en contexto infeccioso, pueden plantear la sospecha inicial de meningitis aguda. Por ello, es necesario que los profesionales sanitarios conozcan las características clínicas y la evolución de estas complicaciones, para así actuar de manera correcta, precoz y eficaz, debido a su potencial gravedad. A continuación, se presentan dos casos de complicaciones supurativas del área otorrinolaringológica que debutaron con clínica cervical: rigidez de nuca o limitación de la movilidad, y que suponen un reto diagnóstico

Suppurative complications of untreated or improperly treated acute pharyngotonsillitis are uncommon. Because of its potential severity, retropharyngeal and parapharyngeal abscess are important. Due to their clinical presentation as a limitation of cervical mobility and/or neck stiffness in an infectious context, they can raise the initial suspicion of acute meningitis. For that, it is necessary for health professionals to know the clinical characteristics and the evolution of these complications, in order to act correctly, early and effectively, due to their potential severity. Below we present two cases of suppurative complications of the otorhinolaryngology area that debuted with a cervical clinic, either with neck stiffness or limited mobility, posing a diagnostic challenge