ABSTRACT
We report the case of a 17-year-old woman who presented to the emergency department on several occasions due to palpitations, tachycardia, syncope, short spells of dizziness and light-headedness with complete spontaneous recovery, and hypertension. The patient had been evaluated by several specialists, and multiple complementary examinations had revealed no abnormalities that could explain the symptoms. Due to suspicion of orthostatic intolerance or postural orthostatic tachycardia syndrome with hypertension, the patient underwent a 60-degree tilt table test, which confirmed the diagnosis. The patient was successfully treated with bisoprolol. The physiopathological mechanisms, diagnosis, and treatment of this syndrome are reviewed.
Subject(s)
Hypertension/complications , Hypotension, Orthostatic/complications , Tachycardia/complications , Adolescent , Female , Humans , Periodicity , Syncope/complications , SyndromeABSTRACT
Se presenta el caso clínico de una mujer de 17 años de edad que acude en reiteradas ocasiones a urgencias por palpitaciones, taquicardia, síncope, reacción vegetativa de escasa duración, con recuperación espontánea y completa y detección de cifras elevadas de presión arterial. Estudiada en diversas consultas de especialidades y tras múltiples exploraciones complementarias no se encontró patología que justificase el cuadro. Ante la sospecha de intolerancia ortostática o síndrome de taquicardia postural ortostática con hipertensión se realizó la prueba de estimulación con cama basculante a 60°, confirmándose el diagnóstico y comprobando la desaparición de los síntomas al iniciar tratamiento con bisoprolol. Se revisan los mecanismos fisiopatológicos, así como el diagnóstico y el tratamiento del mismo
We report the case of a 17-year-old woman who presented to the emergency department on several occasions due to palpitations, tachycardia, syncope, short spells of dizziness and light-headedness with complete spontaneous recovery, and hypertension. The patient had been evaluated by several specialists, and multiple complementary examinations had revealed no abnormalities that could explain the symptoms. Due to suspicion of orthostatic intolerance or postural orthostatic tachycardia syndrome with hypertension, the patient underwent a 60-degree tilt table test, which confirmed the diagnosis. The patient was successfully treated with bisoprolol. The physiopathological mechanisms, diagnosis, and treatment of this syndrome are reviewed
Subject(s)
Female , Adolescent , Humans , Hypertension/complications , Hypotension, Orthostatic/complications , Tachycardia/complications , Periodicity , Syncope/complications , SyndromeABSTRACT
INTRODUCTION: According to current guidelines, hypertension in children should be treated with the same drugs as those used in adults, with adjustment of the dose to their body size. The term therapeutic orphans refers to the lack of information on how to use drugs in children. The aim of this study was to investigate whether the information in the International Vademecum (I-V) is sufficient for the correct use of antihypertensive drugs in children. MATERIAL AND METHOD: We reviewed the data on pediatric dosages of antihypertensive drugs in the I-V (44th and 45th editions). When there were several drugs for the same molecule, the last one marked with the Spanish Ministry of Health and Consumption's logo was selected. When information on a particular drug was not available, the entries for other drugs with the same active principle were reviewed. The information was compared with that provided by the Fourth Report of the National High Blood Pressure Education Program Working Group (NHBPEP). RESULTS: A total of 111 entries for 41 antihypertensive drugs were reviewed. Information on use in children is available for only 3 diuretics and 2 angiotensin converting enzyme inhibitors. The remaining entries either contain no information or indicate that the effectiveness and safety in children has not been evaluated. Some drugs are contraindicated in children. The Fourth Report of the NHBPEP includes pediatric dosages for 28 antihypertensive drugs. The Food and Drug Administration has authorized 10 antihypertensive drugs for use in children. CONCLUSIONS: The information in the V-I can be used to determine the correct dosage of only 5 antihypertensive drugs in children, making this age group authentic therapeutic orphans.
Subject(s)
Antihypertensive Agents/therapeutic use , Hypertension/drug therapy , Antihypertensive Agents/administration & dosage , Child , Humans , SpainABSTRACT
Introducción: Según las guías, la hipertensión en los niños debe tratarse con los mismos fármacos usados en adultos ajustando las dosis al tamaño corporal. El término huérfano terapéutico se refiere a la falta de información sobre el uso de medicamentos en niños. El objetivo es investigar si el Vademécum Internacional (V-I) contiene información para el uso correcto de antihipertensivos en niños. Material y método: Revisión en el V-I de la posología pediátrica de antihipertensivos. Si existen varias especialidades para un fármaco se selecciona el del logotipo del Ministerio de Sanidad y Consumo más reciente. Si en una monografía no hay información, se revisan las de otras especialidades del mismo principio activo. La información se compara con la del 4.º informe del National High Blood Pressure Education Program Working Group (NHBPEP). Resultados: Se revisan 111 monografías de 41 fármacos con indicación de antihipertensivo. Sólo para 3 diuréticos y 2 inhibidores de la enzima conversora de angiotensina (IECA) hay información pediátrica. Las otras advierten de que no se ha establecido la eficacia y seguridad o no hacen referencia a niños. En algunos casos se contraindican. El 4.º informe del NHBPEP incluye dosificación pediátrica de 28 antihipertensivos. La Food and Drug Administration (FDA) tiene autorizados 10 antihipertensivos para uso en niños. Conclusiones: Con la información del V-I sólo es posible dosificar correctamente 5 antihipertensivos en niños, lo que los convierte en auténticos huérfanos terapéuticos
Introduction: According to current guidelines, hypertension in children should be treated with the same drugs as those used in adults, with adjustment of the dose to their body size. The term therapeutic orphans refers to the lack of information on how to use drugs in children. The aim of this study was to investigate whether the information in the International Vademecum (I-V) is sufficient for the correct use of antihypertensive drugs in children. Material and method: We reviewed the data on pediatric dosages of antihypertensive drugs in the I-V (44th and 45th editions). When there were several drugs for the same molecule, the last one marked with the Spanish Ministry of Health and Consumption's logo was selected. When information on a particular drug was not available, the entries for other drugs with the same active principle were reviewed. The information was compared with that provided by the Fourth Report of the National High Blood Pressure Education Program Working Group (NHBPEP). Results: A total of 111 entries for 41 antihypertensive drugs were reviewed. Information on use in children is available for only 3 diuretics and 2 angiotensin converting enzyme inhibitors. The remaining entries either contain no information or indicate that the effectiveness and safety in children has not been evaluated. Some drugs are contraindicated in children. The Fourth Report of the NHBPEP includes pediatric dosages for 28 antihypertensive drugs. The Food and Drug Administration has authorized 10 antihypertensive drugs for use in children. Conclusions: The information in the V-I can be used to determine the correct dosage of only 5 antihypertensive drugs in children, making this age group authentic therapeutic orphans
Subject(s)
Child , Humans , Antihypertensive Agents/therapeutic use , Hypertension/drug therapy , Spain , Antihypertensive Agents/administration & dosageABSTRACT
Epicutaneus tests were used to study 168 children without dermatitis (aged 6 months to 14 years) divided into two groups: 88 atopic cases (53 males and 35 females) and 76 non atopic children (44 males and 31 females). Epicutaneous testing proved positive in 22.7 of atopic children, and in 17.3 por 100 of non atopic cases; there were no statistically significant differences between the two groups, and vesicular reactions predomined in both. Nickel was the contact allergen of greatest predominance among the atopic and non atopic children (17 and 9.3% respectively), followed by mercury derivatives (5.5%), neomycin (2.4%) and dichromates (1.8%).
Subject(s)
Allergens/immunology , Dermatitis, Contact/immunology , Hypersensitivity/immunology , Adolescent , Child , Child, Preschool , Female , Humans , Infant , Intradermal Tests , Male , Mercury/immunology , Nickel/immunologyABSTRACT
This is a study of the ventilatory function (FEF2575, FEF50, PEF) by dry spirometer Vitalograph in 1,566 children of both sexes with ages ranging from 7 to 14 years; 1,156 children (73.6%) were selected as reference population. Height was the biometric parameter with the greatest correlation to the functional variables studied in both sexes, except to PEF in females. Significant differences were observed in functional variables between male and female subjects. Multiple and simple linear regression equations and percentiles tables for each sex are presented.
Subject(s)
Forced Expiratory Flow Rates , Forced Expiratory Volume , Maximal Expiratory Flow Rate , Respiratory Function Tests/methods , Adolescent , Body Height , Child , Female , Humans , Male , Reference Values , Sex Factors , Spain , SpirometryABSTRACT
This is a study of the ventilatory function (FVC, FEV1) by dry spirometer Vitalograph in 1566 children of both sexes with ages ranging from 7 to 14; 1156 children (73.6 per 100) were selected as reference population. Height was the biometric parameter with the greatest correlation to the functional variables studied in both sexes. Significant differences were observed in functional variables between male and female subjects. Multiple and simple linear prediction equations and percentiles tables for each sex are presented. The results of the present study are compared with those of previously published of children.
Subject(s)
Forced Expiratory Flow Rates , Respiratory Function Tests/methods , Vital Capacity , Child , Child, Preschool , Female , Humans , Male , Maximal Expiratory Flow Rate , Reference Values , Spain , SpirometryABSTRACT
A total of 1,566 children the area of Valencia (Spain), of both sexes and aged 7 to 14 received an epidemiological questionnaire recommended by the American Thoracic Society. Antecedents of asthma were recorded in 79 cases (5%), with a predominance among males; 73.3% of these children presented their first crisis before age three. Eighty-seven children were habitual smokers (5.6%), again with a predominance among males-most of these children being between 13 and 14 years old. A family history of smoking was observed in 82.8% of the children who were habitual smokers. A greater predominance of smoking mothers was observed at higher socio-economical levels--with no significant differences between parents. The incidence of respiratory pathology (cough and antecedents of bronchitis) was higher among children whose mothers (or both parents) were smokers. On comparing the two areas of the city with the greatest difference in air pollution level, no significant differences were observed in respiratory morbidity among the child population.
Subject(s)
Asthma/epidemiology , Respiratory Tract Diseases/epidemiology , Air Pollution , Asthma/etiology , Child , Female , Health Surveys , Humans , Male , Respiratory Tract Diseases/etiology , Spain/epidemiology , Surveys and Questionnaires , Tobacco Smoke PollutionABSTRACT
The purpose of this study has been to prove if the lung is the target organ of an allergen against which a biological hypersensitivity, by means of skin test and RAST, has been found; comparing score Foucard diagnostic with inhalatory test result. At the same time, checking test specificity and reproductibility. Fourty children, both sexes aged between 6 and 14 years diagnosed of bronchial asthma divided in two groups were studied. First group included 31 children with hypersensitivity to dermatophagoides and second group was control group including 9 children. The test with dermatophagoides was performed in both groups according to Cockcroft method. The parameters which indicated test positivity were 20% fall in FEV1 for early response and 40% fall in PERF for late response. The results obtained show 83.9% positive tests with 80.6% early responses and 45.2% positive late response. The specificity and reproductibility were of 100%.
