Elaboración de un modelo de herramienta de gestión (Ficha de Transición) para pacientes en transición desde los Servicios de Salud Mental del Niño y el Adolescente hacia la Salud Mental de Adultos / Development of a Management Tool Model (Transition Card) for Patients in Transition from the Child and Adolescent Mental Health Services to Adult Mental Health

INTRODUCCIÓN: En los últimos años ha crecido la preocupación y el interés, tanto en profesionales como en usuarios de los servicios de salud mental, por el proceso de transición que experimentan los pacientes desde las Unidades de Salud Mental del Niño y el Adolescente (USM-NA) a los servicios de Salud Mental de Adultos (CSM). Como resultado de ello, desde principios de siglo han surgido en distintos países numerosos estudios y proyectos para analizar esta situación y poder diseñar un modelo de mejores prácticas para la transición que asegure la continuidad de la atención y el trabajo realizado, aportando la mayor estabilidad posible a nuestros pacientes. OBJETIVO: Siguiendo con esta línea de actuación, el Plan Estratégico de Salud Mental de la Comunidad de Madrid 2018-2020 en su Línea estratégica 2 (Atención a la salud mental en niños y adolescentes) se plantea como objetivo la Implantación de Programas de Transición de los Servicios de Salud mental de Niños y Adolescentes a los de Adultos. Se siguieron las recomendaciones del Plan Estratégico de Salud Mental de la Comunidad de Madrid 2018-2020 en su Línea estratégica 2 y se realizaron reuniones de trabajo por un grupo de profesionales sensibilizados e implicados de forma voluntaria en la mejora de la atención a los pacientes en transición. RESULTADOS: Se presenta la Ficha de Transición que hemos diseñado como herramienta base del programa de transición en nuestra área de atención, siendo el resultado del trabajo multidisciplinar (trabajo social, enfermería, psicología y psiquiatría) de los profesionales, tanto de los CSM como de la USM-NA, que conforman el Grupo para la Transición del Área de Gestión Clínica de Psiquiatría y Salud Mental (AGCPSM) del Hospital 12 de Octubre

INTRODUCTION: During the last years there has been growing concern and interest, in both professionals and users of the mental health services, for the transition process experienced by patients from Child and Adolescent Mental Health (CAMHS) to Adult Mental Health Services (AMHS). As a result, since the beginning of the century, numerous studies and projects have emerged in different countries to analyze this situation and to enable the design of a best-practice model for the transition that ensures the continuity of the attention and the accomplished work, providing the greatest possible stability to our patients. Objetive: Following this line of action, the Strategic Plan for Mental Health of the Community of Madrid 2018-2020 in its Strategic Line 2 (Mental health care in children and adolescents) sets the objective of the Implementation of Services Transition Programs of Mental Health of Children and Adolescents to those of Adults. RESULTS: We present the Transition Card that we have designed, base tool of the transition program in our attention area, as a result of the multidisciplinary work (social work, nursing, psychology and psychiatry) of the professionals, both of the AMHS and the CAMHS, who make up the Group for the Transition of the Area of Clinical Management of Psychiatry and Mental Health (AGCPSM) of Hospital 12 de Octubre

The recent emergence of a highly related virulent Clostridium difficile clade with unique characteristics.

OBJECTIVES: Clostridium difficile is a major global human pathogen divided into five clades, of which clade 3 is the least characterized and consists predominantly of PCR ribotype (RT) 023 strains. Our aim was to analyse and characterize this clade. METHODS: In this cohort study the clinical presentation of C. difficile RT023 infections was analysed in comparison with known 'hypervirulent' and non-hypervirulent strains, using data from the Netherlands national C. difficile surveillance programme. European RT023 strains of diverse origin were collected and whole-genome sequenced to determine the genetic similarity between isolates. Distinctive features were investigated and characterized. RESULTS: Clinical presentation of C. difficile RT023 infections show severe infections akin to those seen with 'hypervirulent' strains from clades 2 (RT027) and 5 (RT078) (35%, 29% and 27% severe CDI, respectively), particularly with significantly more bloody diarrhoea than RT078 and non-hypervirulent strains (RT023 8%, other RTs 4%, p 0.036). The full genome sequence of strain CD305 is presented as a robust reference. Phylogenetic comparison of CD305 and a further 79 previously uncharacterized European RT023 strains of diverse origin revealed minor genetic divergence with >99.8% pairwise identity between strains. Analyses revealed distinctive features among clade 3 strains, including conserved pathogenicity locus, binary toxin and phage insertion toxin genotypes, glycosylation of S-layer proteins, presence of the RT078 four-gene trehalose cluster and an esculinase-negative genotype. CONCLUSIONS: Given their recent emergence, virulence and genomic characteristics, the surveillance of clade 3 strains should be more highly prioritized.

Fluticasone in mild to moderate atopic dermatitis relapse: a randomized controlled trial

BACKGROUND: The long-term efficacy of corticosteroids to prevent atopic dermatitis (AD) relapses has partially been addressed in children. This study compared an intermittent dosing regimen of fluticasone propionate (FP) cream 0.05% with its vehicle base in reducing the risk of relapse in children with stabilized AD. METHODS: A randomized controlled, multicentric, double-blind trial was conducted. Children (2-10 years) with mild/moderate AD (exclusion criteria: >30% affected body surface area and/or head) were enrolled into an Open-label Stabilization Phase (OSP) of up to 2 weeks on twice daily FP. Those who achieved treatment success entered the Double-blind Maintenance Phase (DMP). They were randomly allocated to receive FP or vehicle twice-weekly on consecutive days for 16 weeks. The primary study endpoint was relapse rate; time to relapse and severity of disease were also studied. Kaplan-Meier estimates were calculated. RESULTS: Fifty-four patients (29 girls) entered the OSP (23 mild AD) and 49 (26 girls) continued into the DMP. Mean age was 5.5 (SD: 2.8) and 5.1 (SD: 2.3) yrs for FP and vehicle groups, respectively. Four patients withdrew from the DMP (two in every group). Patients treated with FP twice weekly had a 2.7 fold lower risk of experiencing a relapse than patients treated with vehicle (relative risk 2.72, SD: 1.28; p = 0.034). FP was also superior to vehicle for delaying time to relapse. Both treatment therapies were well tolerated. CONCLUSION: This long-term study shows that twice weekly FP provides an effective maintenance treatment to control the risk of relapse in children with AD

No disponible

Fluticasone in mild to moderate atopic dermatitis relapse: A randomized controlled trial.

BACKGROUND: The long-term efficacy of corticosteroids to prevent atopic dermatitis (AD) relapses has partially been addressed in children. This study compared an intermittent dosing regimen of fluticasone propionate (FP) cream 0.05% with its vehicle base in reducing the risk of relapse in children with stabilized AD. METHODS: A randomized controlled, multicentric, double-blind trial was conducted. Children (2-10 years) with mild/moderate AD (exclusion criteria: >30% affected body surface area and/or head) were enrolled into an Open-label Stabilization Phase (OSP) of up to 2 weeks on twice daily FP. Those who achieved treatment success entered the Double-blind Maintenance Phase (DMP). They were randomly allocated to receive FP or vehicle twice-weekly on consecutive days for 16 weeks. The primary study endpoint was relapse rate; time to relapse and severity of disease were also studied. Kaplan-Meier estimates were calculated. RESULTS: Fifty-four patients (29 girls) entered the OSP (23 mild AD) and 49 (26 girls) continued into the DMP. Mean age was 5.5 (SD: 2.8) and 5.1 (SD: 2.3) yrs for FP and vehicle groups, respectively. Four patients withdrew from the DMP (two in every group). Patients treated with FP twice weekly had a 2.7 fold lower risk of experiencing a relapse than patients treated with vehicle (relative risk 2.72, SD: 1.28; p=0.034). FP was also superior to vehicle for delaying time to relapse. Both treatment therapies were well tolerated. CONCLUSION: This long-term study shows that twice weekly FP provides an effective maintenance treatment to control the risk of relapse in children with AD.

The Clostridium difficile PCR ribotype 027 lineage: a pathogen on the move.

Clostridium difficile is a Gram-positive, spore-forming, human and animal pathogen that is the major cause of antibiotic-associated diarrhoea worldwide. The past decade has seen the rapid emergence of the hypervirulent PCR ribotype (RT) 027 complex, which has been associated with increases in the incidence and severity of disease and mortality. In this review, we describe the potential virulence factors that have been reported in strains from the RT 027 complex. We review the emergence, population structure, dissemination and evolution of this lineage.

Diagnóstico de síndrome de Cowden a partir de una fibropapilomatosis oral múltiple: un caso excepcional en la edad pediátrica / Diagnosis of Cowden’s syndrome based on the identification of oral fibropapillomas: a rare case in pediatric age

El síndrome de Cowden es una enfermedad hereditaria rara, caracterizada por la presencia de una poliposis gastrointestinal de tipo hamartomatoso, anomalías cutaneomucosas y riesgo aumentado de neoplasias, sobre todo de mama, tiroides y genitourinarias; de ahí la importancia de su diagnóstico temprano. Presentamos el caso de una niña de 10 años de edad, remitida al servicio de pediatría desde el de estomatología por la sospecha de un síndrome de Cowden, dada la presencia de fibropapilomas orales. En el estudio realizado se constata la presencia de criterios clínicos mayores (macrocefalia) y menores (nódulos tiroideos, poliposis intestinal) que permiten su diagnóstico, pendiente de los resultados del gen supresor tumoral PTEN. Este diagnóstico precoz permitirá realizar revisiones periódicas para prevenir o detectar inicialmente enfermedades malignas, por lo que consideramos muy importante que el pediatra piense en este síndrome ante lesiones orales en apariencia banales(AU)

Cowden syndrome is a rare hereditary disease characterized by hamartoma-type gastrointestinal polyposis, mucocutaneous anomalies and high susceptibility to develop malignant neoplasia, mainly in the breast, thyroid and genitor-urinary tract, so early diagnosis is very important. We present the case of a ten years-old child diagnosed with Cowden syndrome after consultation for oral fibropapillomas to stomatologist. She presented major diagnostic criteria (macrocephaly) and minor diagnostic criteria (thyroid lesion and gastrointestinal polyps). We are wating for mutation in the tumor suppressor gene PTEN. This early diagnosis makes possible an adequate tumoral screening after a correct diagnosis of a banal pathology of oral mucosa, so is very important that paediatricians know this syndrome(AU)

Quality of life in hearing-impaired children with bilateral hearing devices.

OBJECTIVE: To evaluate the quality of life (QOL) of hearing-impaired children fitted with either a cochlear implant and a hearing aid or bilateral hearing aids, and to compare their outcomes with those of normal-hearing peers. We also investigated the impact of demographic, clinical, and audiological results on QOL. METHODOLOGY: Cross-sectional study using a generic QOL questionnaire. Questionnaires were completed by children and their parents. Eighty-eight children were divided into three groups: bilateral deaf children with a cochlear implant and a contralateral hearing aid (bimodal group), bilateral deaf children with bilateral hearing aids (hearing aid group), and normal-hearing children. The Spanish version of the KINDLr test was used. Responses were correlated with demographic, clinical, and audiological data. RESULTS: The questionnaires revealed a high health-related QOL with a total self-rating score for the children and a proxy score for the parents of 75 or higher in five out of six domains. No significant difference was found in the QOL among the three groups. Additionally, there was no significant difference between the self-rating and the proxy total scores, and no significant association was found between the QOL and the variables of the study. CONCLUSION: Our results indicate a high level of QOL in hearing-impaired children and their families following treatment with either bilateral hearing aids or bimodal stimulation. Children and their parents reported a QOL similar to that of normal-hearing children.

A comparative epizootiologic study of the two fish-pathogenic serovars of Vibrio vulnificus biotype 2.

Vibrio vulnificus biotype 2 is subdivided into two main serovars, serovar E, able to infect fish and humans, and serovar A, only virulent for fish. Serovar E emerged in 1976 as the causative agent of a haemorrhagic septicaemia (warm-water vibriosis) affecting eels cultured in brackish water. Serovar A emerged in 2000 in freshwater-cultured eels vaccinated against serovar E, causing warm-water vibriosis with fish showing a haemorrhagic intestine as the main differential sign. The aim of the present work was to compare the disease caused by both serovars in terms of transmission routes, portals of entry and host range. Results of bath, patch-contact and oral-anal challenges demonstrated that both serovars spread through water and infect healthy eels, serovar A entering mainly by the anus and serovar E by the gills. The course of the disease under laboratory conditions was similar for both serovars in terms of transmission and dependence of degree of virulence on water parameters (temperature and salinity). However, the decrease in degree of virulence in fresh water was significantly greater in serovar E than in serovar A. Finally, both serovars proved pathogenic for tilapia, sea bass and rainbow trout, but not for sea bream, with significant differences in degree of virulence only in rainbow trout. In conclusion, serovar A seems to represent a new antigenic form of V. vulnificus biotype 2 with an unusual portal of entry and is better adapted to fresh water than serovar E.

Microbial and histopathological study of the vibriosis caused by Vibrio vulnificus serovar E in eels: the metalloprotease Vvp is not an essential lesional factor.

Vibrio vulnificus biotype 2 serovar E (Bt2-serE) is a zoonotic pathogen that causes a haemorrhagic septicaemia in eels, called warm water vibriosis. The main objective of the present work was to study the onset of the eel vibriosis from the microbiological and histopathological viewpoint, as well as to ascertain the role of the protease Vvp as a lesional factor by comparing the histopathological lesions caused by the wild strain and its vvp deficient derivative. The wild-type strain was observed to attach to the gills, where it multiplied following saturation dynamics, subsequently invading the blood stream and reaching the internal organs. Here it reached population sizes that are notably lower than those associated with other fish septicaemia. Parallel to bacterial growth, there was a notable decrease in haematocrit values and haemoglobin concentration in blood as well as extensive haemorrhages in all the analysed organs. The main histopathological lesions were detected in the head kidney in the form of extensive necrosis affecting the haematopoietic tissue. Very few bacteria were visualized in the different organs, most of which were close to blood cells and capillary vessels, which is compatible with the results obtained in the microbiological study. The same lesions were produced when extracellular products (ECPs) were injected instead of bacteria or when the vvp-defective mutant or its ECPs were injected. The overall results suggest that the pathology caused by V. vulnificus in the eel is not caused by massive bacterial growth in the blood and internal organs but, rather, by the effect of potent toxic factors other than the metalloprotease, which have yet to be determined.

Role of the virulence plasmid pR99 and the metalloprotease Vvp in resistance of Vibrio vulnificus serovar E to eel innate immunity.

Vibrio vulnificus biotype 2 serovar E (VSE) is a bacterial pathogen that produces a haemorrhagic septicaemia called vibriosis in eels. Its ability to grow in blood is conferred by a recently described virulence plasmid [Lee CT, Amaro C, Wu KM, Valiente E, Chang YF, Tsai SF, et al. A common virulence plasmid in biotype 2 Vibrio vulnificus and its dissemination aided by a conjugal plasmid. Journal of Bacteriology, submitted for publication.]. In this study, we analyzed the role of this plasmid together with the role played by the metalloprotease (Vvp) in the interaction between bacteria and eel innate immunity. To this end, we compared and statistically analyzed the differences in resistance to serum and mucus factors (complement, selected antimicrobial peptides, transferrin and lysozyme) and also to phagocytosis/opsonophagocytosis between one VSE strain and its derivatives: a plasmid-cured strain and a vvp-deficient mutant. The wild-type and the metalloprotease-deficient strains were resistant to both the bactericidal action of fresh serum and the phagocytosis and opsonophagocytosis by eel phagocytes, confirming that Vvp is not involved in resistance to eel innate immunity. In contrast, the cured strain was sensitive to both the bactericidal action of eel serum activated by the alternative pathway and phagocytosis/opsonophagocytosis. Since no plasmid-encoded ORF, with homology to known genes, is related to the resistance to innate immunity [Lee CT, Amaro C, Wu KM, Valiente E, Chang YF, Tsai SF, et al. A common virulence plasmid in biotype 2 Vibrio vulnificus and its dissemination aided by a conjugal plasmid. Journal of Bacteriology, submitted for publication.], this function could be codified by one or more new genes. Further studies are underway to characterize the plasmid-encoded system responsible for V. vulnificus resistance to the innate immune system of eels.

Neurotóxicos medioambientales (IV). Tabaco, alcohol, solventes, flúor y aditivos alimentarios: efectos adversos en el sistema nervioso fetal y postnatal y medidas preventivas / Environmental neurotoxins (IV). Tobacco, alcohol, solvents, fluoride, food additives: adverse effects on the fetal and postnatal nervous system. Preventive measures

Objetivos: 1) Divulgar la neurotoxicidad del humo del tabaco, alcohol y otros solventes, flúor y algunos aditivos alimentarios, y 2) recomendar las medidas preventivas para minimizar/eliminar su exposición. Materiales y métodos: Revisión bibliográfica sistemática de los efectos en el sistema nervioso central (SNC) en desarrollo. Búsqueda en MEDLlNE. Science Citation Index y Embase de los trabajos observacionales de exposición a bajas dosis en humanos y de experimentación en animales de los últimos 10 años. Resultados: 1) El tabaquismo activo y pasivo de las madres gestantes provoca trastornos del aprendizaje, déficit de atención y del cociente intelectual (CI) persistente, y está asociado con un menor rendimiento académico en la descendencia, 2) la exposición fetal a bajas dosis de alcohol se ha asociado con hiperactividad, trastornos de atención, de aprendizaje y deterioro de la memoria en la descendencia; 3) la exposición a solventes por hobbies o aficiones en el hogar puede ser un factor de riesgo considerable, especialmente en áreas mal ventiladas, 4) estudios en animales y humanos sugieren que la exposición al flúor, a los niveles a que se expone la población por fluoración del agua potable y otros suplementos, puede tener efectos adversos sobre el neurodesarrollo. y 5) en animales de experimentación los efectos neurotóxicos por aspartamo y glutamato requieren dosis mucho mayores que las de la dieta humana. Conclusiones: 1) El SNC fetal e infantil es especialmente vulnerable a la exposición a bajas dosis de humo de tabaco y alcohol; 2) no existe un nivel seguro de exposición ni para el tabaco ni para el alcohol; 3) el registro en la consulta de los hobbies o aficiones en el hogar con solventes permitirá detectar familias en riesgo; 4) los suplementos de flúor sólo están indicados en poblaciones de riesgo; 5) la relación entre la dieta y el comportamiento en niños con trastornos de déficit de atención e hiperactividad es incierta, y 6) la historia ambiental pediátrica es necesaria para avanzar en el conocimiento y en los aspectos preventivos, pronósticos y evolutivos de las enfermedades relacionadas con estas exposiciones

Objectives: 1) To make pediatricians aware of the neurotoxicity of: a) tobacco smoke, b) alcohol and other solvents, c) fluoride, and d) certain food additives; and 2) to recommend preventive measures to minimize/eliminate fetal and postnatal exposure. Materials and methods: A systematic review of the literature was conducted to explore the toxic effects of these substances on the fetal and postnatal nervous system. The authors carried out a search for the observational studies on low-dose exposure in humans and laboratory animals indexed over the past 10 years in Medline, the Science Citation Index and Embase. Results: 1) The exposure of women to first hand and second hand cigarette smoke during pregnancy leads to learning disabilities, persistent attention deficits and a low intelligence quotient (IQ) in their children, resulting in poorer academic performance. 2)Fetal exposure to low doses of alcohol is associated with hyperactivity, attention and learning deficits, and poor memory in the child. 3) Exposure to solvents employed in hobbies and pastimes in the home can be a considerable risk factor, especially in poorly ventilated areas. 4) Animal and human studies suggest that exposure to fluoride, at levels similar to those foundin fluoridated drinking water, and to other supplements can have adverse effects on neuronal development. 6) In animal studies, the adverse effects of aspartame and glutamatea re produced at much higher doses than those found in the human diet. Conclusions: 1)The fetal and postnatal central nervous system is especially vulnerable to low-dose exposure to cigarette smoke and alcohol. 2) There are no threshold levels of exposurefor cigarette smoke and alcohol. 3) During well-child visits, the recording pastime and hobbies that involves the use of solvents enables the detection of families at risk. 4) Fluoride supplements are indicated only in populations at risk. 5) Therelation ship between diet and the behavior of children with attention deficit hyperactivity disorder (ADHD) is unclear. 6) The Pediatric Environmental History (PEH) is necessary to expandour knowledge of the health hazards related to these exposures in terms of prevention, prognosis and outcome

¿Se debe formar el residente de Pediatría en Atención Primaria? ¿Por qué? Encuesta a pediatras y residentes de Valencia / No disponible

Introducción y objetivos: considerando que el residente de Pediatría no se forma en puericulturani en prevención y promoción de salud del niño sano en centros de Atención PediátricaPrimaria, ni para el tratamiento del niño que no precisa atención hospitalaria, se intentasaber si el residente debe formarse en Atención Primaria.Material y métodos: para ello se distribuyó una encuesta anónima dirigida a todos lospediatras que prestan la Atención Primaria en la ciudad de Valencia, a todos los pediatras delHospital La Fe y a todos los residentes de Pediatría de dicho hospital. Se preguntó: ¿Creesque el residente de Pediatría debe rotar –también– por un centro de Atención Primaria acreditadopara completar su formación? Y ¿por qué?Resultados: se obtuvo un porcentaje de respuesta del 44,7%. El 86% respondió sí, el13% no y el 1% en blanco. Dijeron sí el 90% de los pediatras (95% de Primaria y 83% dehospital) y el 50% de los residentes. Los encuestados respondieron a la segunda parte de lapregunta y aportaron su opinión respecto a los motivos a favor de la rotación en AtenciónPediátrica Primaria; el 29% aportó ideas respecto al programa de formación del residente. El13% que opinó que no debe rotar justificó su opinión y aportó ideas para la formación delresidente. Conclusiones: el 86% de encuestados opina que el residente de Pediatría debe rotar porAtención Primaria para completar su formación y el 17% reclama alargar a más de cuatro añosla especialidad de Pediatría

Introduction and objectives: considering that the resident physician in the specialty ofpaediatrics in Valencia never trains in Paediatric Primary Care centres and that he does notreceive any preparation in child care nor in aspects as preventive care and promotion of goodhabits in healthy children or the treatment of ill children who do not need hospitalization,our intention is to find out if residents should be trained in Paediatric Primary Care, accordingto the opinion of paediatricians and residents in paediatrics.Material and methods: for this reason, an anonymous survey was carried out directed toall paediatricians in Primary Care in the city of Valencia and to all paediatricians and residentsin paediatrics who practise hospital care in the Hospital La Fe. The questions were: Doyou think that a paediatric resident should train –additionally– in an accredited primary healthcare center in order to complete his training? Why?Results: a percentage of 44.7% answered. Eighty-six per cent answered yes, 13% no and1% blank. Affirmative responses were from 90% of the paediatricians (95% primary carepaediatricians and 85% hospital care paediatricians) and 50% of the residents. Those surveyedresponded to the second part of the question giving their opinion on the motives in favourof Paediatric Primary Care training. 29% offered ideas for the resident training program,the 13% against Paediatric Primary Care training, that justified with their opinions.Conclusions: 86% say the resident should be trained in Paediatric Primary Care and17% demand more than four years’ training in Paediatrics

mrpA, a gene with roles in resistance to Na+ and adaptation to alkaline pH in the cyanobacterium Anabaena sp. PCC7120.

Transposon mutagenesis of Anabaena sp. PCC7120 led to the isolation of a mutant strain, PHB11, which grew poorly at pH values above 10. The mutant strain exhibited pronounced Na+ sensitivity; this sensitivity was higher under basic conditions. Mutant PHB11 also showed an inhibition of photosynthesis that was much more pronounced at alkaline pH. Reconstruction of the transposon mutation of PHB11 in the wild-type strain reproduced the phenotype of the original mutant. The wild-type version of the mutated gene was cloned and the mutation complemented. In mutant strain PHB11, the transposon had inserted within an ORF that is part of a seven-ORF operon with significant sequence similarity to a family of bacterial operons that are believed to code for a novel multiprotein cation/proton antiporter primarily involved in resistance to salt stress and adaptation to alkaline pH. The Anabaena operon was denoted mrp (multiple resistance and pH adaptation) following the nomenclature of the Bacillus subtilis operon; the ORF mutated in PHB11 corresponded to mrpA. Computer analysis suggested that all seven predicted Anabaena Mrp proteins were highly hydrophobic with several transmembrane domains; in fact, the predicted protein sequences encoded by mrpA, mrpB and mrpC showed significant similarity to hydrophobic subunits of the proton pumping NADH : ubiquinone oxidoreductase. In vivo expression studies indicated that mrpA is induced with increasing external Na+ concentrations and alkaline pH; mrpA is also upregulated under inorganic carbon (Ci) limitation. The biological significance of a putative cyanobacterial Mrp complex is discussed.

Neurotóxicos medioambientales (I). Pesticidas: efectos adversos en el sistema nervioso fetal y posnatal / Environmental neurotoxins. Pesticides: adverse effects on the fetal and postnatal nervous system

Introducción: Los pediatras diagnosticamos, cada vez, más pacientes con enfermedades neurológicas (cognitivas, conductuales, motoras, sensoriales y malformativas). Determinar sus causas es, con frecuencia, extremadamente difícil. Los trastornos del aprendizaje, conducta y desarrollo en los niños son el resultado de complejas interacciones entre factores ambientales (físicos, químicos, biológicos, psicológicos y sociales) y genéticos durante los periodos vulnerables del desarrollo. Material y métodos: Revisión bibliográfica sistemática sobre los efectos de los pesticidas y otras sustancias tóxicas para el sistema nervioso en desarrollo. Búsqueda en las bases de datos Medline, Science Citation Index y Embase de los últimos diez años sobre los trabajos observacionales de exposición a bajas dosis en humanos y de experimentación en animales. Resultados: 1) Los neurotóxicos son una amenaza real para los niños y, a veces, sus efectos adversos aparecen con exposiciones a niveles actualmente aceptados como seguros; 2) sólo unos pocos han sido ampliamente estudiados, mientras que sobre la mayoría se ha efectuado una investigación mínima; y 3) los principales efectos neurotóxicos derivados de la exposición fetal y durante los primeros años de vida a los pesticidas son la presencia de hiperactividad, pérdida de vitalidad, alteraciones de la coordinación y de la memoria, disminución de la capacidad de dibujar, retraso en el desarrollo neurológico, desórdenes conductuales y alteraciones motoras. Conclusiones: 1) Los neurotóxicos pueden alterar el desarrollo y funciones del cerebro de manera específica y de forma permanente; 2) la mayoría de pesticidas son especialmente neurotóxicos durante los periodos fetal y neonatal;3) los pediatras debemos efectuar recomendaciones sobre la búsqueda de alternativas, minimización y eliminación del uso de pesticidas en el entorno infantil; y 4) debemos exigir estudios detallados sobre la neurotoxicidad de los pesticidas antes de que se les otorgue la licencia para su uso comercial

Introduction: Pediatricians are diagnosing a growing number of patients with neurological disorders (cognitive, behavioral, motor, sensory and malformative). It is often extremely difficult to determine their causes. Learning, behavioral and developmental disabilities in children are clearly the result of complex interactions between environmental factors (physical, chemical, biological, psychological and social) and genetic factors occurring during the vulnerable periods of development. Material and methods: A systematic literature search was carried out to explore the effects of pesticides and other substances that are toxic to the developing nervous system. The search was carried out in Medline, the Science Citation Index and Embase and involved observational studies on low-dose exposure in humans and on animal experimentation over the past 10 years. Results: 1) Neurotoxins are a real threat to children and the adverse effects sometimes appear after exposure to levels currently considered safe; 2) a few have been extensively studied, while research on the majority has been minimal; and 3) the major neurotoxic effects derived from the exposure to pesticides of fetuses and children during the first few years of life are hyperactivity, loss of vitality, changes in coordination and memory performance, diminished ability to draw, delayed neurological development and behavioral and motor disorders. Conclusions: 1) Neurotoxins can affect the development and functions of the brain in a specific and permanent manner; 2) the majority of pesticides are especially neurotoxic during the fetal and neonatal periods; 3) pediatricians should offer recommendations aimed at the search for alternatives and the minimization and elimination of the use of pesticides in children's environments; and 4) we should demand detailed studies on the neurotoxicity of pesticides before their manufacturers are granted licenses for their commercial use

Protocolo de prevención y tratamiento de las complicaciones del síndrome de intestino corto / Protocol for the prevention and treatment of the complications associated with short bowel syndrome (and II)

No disponible

Malaria importada en el niño. Estudio de 17 casos y revisión de la literatura / Imported malaria in children: a study of 17 cases and a review of the literature

Objetivo: Estudiar las características de todos los niños diagnosticados de malaria en nuestro hospital en los últimos 20 años, y realizar una revisión bibliográfica sobre los problemas clínicos, diagnósticos, terapéuticos y profilácticos de la malaria en el niño. Material y métodos: Se diagnosticaron 17 niños de malaria en los últimos 20 años (mediante examen de gota gruesa), en la sección de Infectocontagiosos del Hospital Infantil "La Fe" de Valencia, todos ellos en la última década. Se estudiaron sus problemas con respecto a diagnóstico, procedencia, comorbilidad, clínica, datos de laboratorio, tratamiento y evolución. Resultados: Todos los pacientes habían nacido en un país endémico, o eran hijos de inmigrantes que habían viajado recientemente al país de sus padres. La incidencia anual oscila entre 1 caso en 1993 y 4 en 2000. La mayoría de ellos (12) estaban parasitados por Plasmodium falciparum; el país de procedencia mayoritario era Guinea Ecuatorial. La fiebre fue la única característica clínica constante. La evolución tras el tratamiento fue buena en todos los casos. Conclusiones: La malaria es una enfermedad rara entre nosotros, pero su incidencia está incrementándose debido a los grandes cambios sociales, sobre todo por la inmigración. Dada la importancia de un diagnóstico y tratamiento precoces, los pediatras deberían pensar en la malaria ante cualquier niño febril que haya permanecido durante el año anterior en un país endémico (AU)

Protocolo de prevención y tratamiento de las complicaciones del síndrome de intestino corto (I) / Protocol for the prevention and treatment of the complications associated with short bowel syndrome (I)

El síndrome de intestino corto es un proceso de malabsorción que aparece tras una resección intestinal, que precisa nutrición parenteral prolongada, para evitar la malnutrición consiguiente, y, posteriormente, nutrición enteral, con fórmulas alimentarias especiales. El objetivo del tratamiento del síndrome de intestino corto es mantener el crecimiento y estado nutricional adecuados, promover la adaptación del intestino residual, evitar las complicaciones y, en su caso, tratarlas. Existe un número creciente de pacientes que sobreviven tras sufrir grandes resecciones intestinales, debido a diagnósticos más precoces y a la mejora de las técnicas quirúrgicas y de los cuidados intensivos. Por ello, está aumentando el número de pacientes resecados que evolucionan hacia el desarrollo de un síndrome de intestino corto, siendo cada vez más numerosas las complicaciones provocadas por éste. Existen numerosas publicaciones que hacen referencia al tratamiento nutricional del síndrome de intestino corto, así como estudios experimentales y clínicos que muestran cómo promover la adaptación del intestino residual. Sin embargo, hay menos información sobre la prevención y el tratamiento de las complicaciones más frecuentes. El objetivo del presente trabajo es revisar las pautas de prevención y, en su caso, de tratamiento, de dichas complicaciones (AU)

Infección perinatal por citomegalovirus en recién nacidos pretérmino / Perinatal cytomegalovirus infection in preterm infants

Objetivo: Estudiar la incidencia de infección perinatal por citomegalovirus en los recién nacidos ingresados en nuestro hospital en los últimos 3 años, las posibles fuentes de contagio, los datos serológicos y microbiológicos y la evolución clínica de los niños. Métodos: Estudio retrospectivo. Revisión de historias clínicas de los neonatos con diagnóstico de infección por citomegalovirus. Resultados: Se encontraron 24 niños con este diagnóstico. El 85% de los niños eran prematuros, con peso menor de 1.500 g, los cuales representan el 6% de los niños con ese peso ingresados en este período. El porcentaje de transfusión y lactancia materna fue elevado (87 y 91%, respectivamente), por lo que la fuente de contagio no pudo establecerse. Nueve (34%) de los niños presentaron afectación hepática y 3 (12%) tuvieron un cuadro clínico grave que precisó tratamiento antiviral. Conclusiones: La infección perinatal por citomegalovirus es una enfermedad frecuente en el grupo de niños prematuros, que puede llegar a ser grave. Es importante pensar en su diagnóstico e insistir en la prevención (AU)

[Perinatal cytomegalovirus infection in preterm infants]. / Infección perinatal por citomegalovirus en recién nacidos pretérmino.

OBJECTIVE: To study the incidence of perinatal cytomegalovirus infection in neonates admitted to our hospital in the last three years, as well as the mode of transmission, serologic and microbiologic data, and the clinical outcome of these infants. METHODS: We performed a retrospective study by reviewing the medical records of neonates with a diagnosis of cytomegalovirus infection. RESULTS: Twenty-four neonates received this diagnosis. Of these, 21 (85 %) were premature infants with a birthweight of less than 1500 gr, representing 6 % of all neonates with this birthweight hospitalized during the study period. The percentage of transfusion and breastfeeding was high (87 % and 91 %, respectively) and consequently the route of transmission could not be identified. Nine neonates (34 %) presented associated hepatic dysfunction and three (12 %) developed severe disease requiring antiviral treatment. CONCLUSIONS: Perinatal cytomegalovirus infection is frequent in preterm infants and may be serious. It is important to detect cytomegalovirus infections and to develop preventive methods.

Changes in carboxysome structure and grouping and in photosynthetic affinity for inorganic carbon in Anabaena strain PCC 7119 (Cyanophyta) in response to modification of CO2 and Na+ supply.

In ANABAENA: PCC 7119 a 4-fold decrease in the value of the apparent photosynthetic affinity for external inorganic carbon [K1/2 (Ci)] occurred between 9 and 12 h after the transfer from high-CO2 (2% CO2-enriched air) to air-growing conditions. A slight increase in carboxysome frequency occurred, but during this transition their appearance and distribution remained unchanged. ANABAENA: PCC 7119 did not improve its K1/2 (Ci) beyond the above cited level of acclimation neither by culturing the cyanobacteria in Na+-deficient medium in air nor by aeration with CO2-depleted air. In air-grown cultures, Na+ deficiency induced a large increase in carboxysome frequency and an alteration of their appearance: the greatest proportion were electron-dense whereas this type constituted a minority in high-CO2 and in air, Na+-sufficient conditions. It also induced major changes in carboxysome distribution, whereby more than 60% were grouped, compared with only 10% in high-CO2 and in air, Na+-sufficient conditions. These changes in carboxysome expression were extremely rapid, occurring mainly during the first 2 h.