Diagnóstico y tratamiento de una tuberculosis pulmonar cavitada en un lactante / Insulin pump therapy in a 21-month-old boy

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El gasto por la mala utilización de los servicios de urgencia pediátricos: un problema de todos / Expenses incurred by the poor utilization of pediatric emergency services: a problem that affects everyone

Se valoran los gastos sanitarios producidos como consecuencia de una mala utilización de las urgencias pediátricas en un centro cuya cobertura supera los 350.000 habitantes. Se reflexiona sobre el detrimento que implica, tanto para el área primaria que asiste, como para estos servicios (AU)

[Accidental punctures: ten years of experience with our protocol]. / Punturas accidentales: Diez años de experiencia con nuestro protocolo.

OBJECTIVE: We report our experience during the past 10 years in the management of accidental punctures. PATIENTS AND METHODS: A study was made of all hypodermic needle punctures recorded in children aged 0-14 years in our center since 1987. A clinical protocol consisting of 5 visits and duration of 6-7 months was used in all cases. RESULTS: A total of 150 punctures were recorded during the study period with a decrease in prevalence over time. All cases the clinical protocol was accepted and correct follow-up procedures were performed. In no case was post-puncture sero-conversion detected for HCV, HBV, or HIV among correctly immunized children. CONCLUSIONS: The protocol employed is useful and well accepted with the risk of infection caused by accidental puncture being remote provided initial patient care was adequate.

[Pediatric cranio-encephalic trauma in the emergency ward]. / Consideraciones sobre los traumatismos craneoencefálicos pediátricos desde un servicio de urgencias.

OBJECTIVES: A study was made of head injuries among children treated in hospital emergency services, along with an analysis of the corresponding health care pressures, type of treatment and possibilities of prevention. MATERIAL AND METHODS: A retrospective analysis was made of the last 152 pediatric head injuries seen in our center, with an evaluation of patient age, the cause and place of injury, and the individuals present at the time of the injury. When, where and what form of first aid was provided was also studied, along with the time elapsed before the arrival at the center, the reason for the consultation, severity of the injury and the treatment dispensed. The costs entailed are also evaluated. RESULTS: During the study period, pediatric head injuries accounted for 5.25% of healthcare demands. A large majority of the injuries took place at home, in parks or at school (95.39%), in the presence of relatives or tutors, and with a male predominance of 2:1. In terms of age and sex distribution, two well differentiated groups were established, corresponding to ranges of 0-7 and 7-14 years. On the average, 30-40 minutes elapsed between the injury and arrival at the Emergency Room with most cases (80.27%) corresponding to minor injuries. Moderate head trauma accounted for 19.73% of the cases. Evaluation in the form of anamnesis and clinical exploration, with a 24 hour guided observation period, proved to be the most effective approach. Only 1.97% of the patients required cranial CAT exploration, with head X-rays proving to be ineffective and to generate unnecessary costs in all cases. CONCLUSIONS: The management of pediatric head injuries should be returned to the charge of the primary healthcare areas. The adoption of such measure would improve prevention and treatment, while curbing costs. Cranial radiological exploration should be discarded as a complementary evaluation parameter. Within each particular healthcare area, common protocols should be established to facilitate the follow-up of these patients from the time of first arrival, including a 24 hour guided observation period even in the case of only slight head injuries.

[Bronchial hyperreactivity in infancy]. / Hiperreactividad bronquial en la infancia.

Airway responsiveness may be defined as the case with which airways narrow upon exposure to physical and chemical stimuli and drugs. Bronchial hyperresponsiveness reflects an excessive bronchoconstricting response to these stimuli. Although in part it may be genetically mediated, a number of environmental factors (allergens, viruses and contaminants) are also involved in increasing bronchial responsiveness through airway inflammation. We review the concept, etiology, pathogeny, clinical expression, diagnosis, preventative measures and treatment of bronchial hyperresponsiveness in pediatrics.

[Iga and IgG antireticuline in celiac disease. Their application as diagnostic markers of the disease]. / Estudio de la reactividad IgA e IgG antirreticulina en la enfermedad celíaca. Su aplicación como marcador diagnóstico de la enfermedad.

We report the results of indirect immunofluorescent (IFI) detection of IgA and IgG antireticulin antibodies (IgA-ARA and IgG-ARA, respectively) in 283 serum samples from pediatric patients with coeliac disease (with and without gluten containing diets), patients with non-coeliac gastrointestinal disease, patients without gastrointestinal disease (control group) and patients with an increased risk for coeliac disease (diabetes mellitus, dermatitis herpetiformis or first grade relatives of coeliac patients). Our results indicate that IgA-ARA is a reproducible marker, with high positive (99-100%) and negative (100%) prediction values, when it is applied to children who have been on gluten containing diets for a long time (more than six months). The IgA-ARA measurement is not applicable in cases of selective IgA deficiency. Although IgG-ARA has a high predictive positive value, its low predictive negative value makes it a poor diagnostic tool. In the risk groups, our results suggest that these antibodies are useful in patient selection for intestinal biopsy.

[Adoption of HIV positive children. A rarely discussed subject requiring immediate solution]. / La adopción de los niños VIH(+). Un tema escasamente tratado que requiere soluciones inmediatas.

After programme a inquiry-type this carry out itself amongst the families that adopted children with antibodies from the human immunodeficiency virus (AcVIH) in, they communicate the facts collected about the problematic that raise their adoption. They provide some conclusions.

[Prevalence of sensitivity to contact allergens among atopic and non atopic children without dermatitis]. / Prevalencia de la sensibilización a alergenos de contacto entre la población infantil atópica y no atópica sin dermatitis.

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%).

[Exercise test in exercise-induced asthma in children: study of delayed response]. / El test de esfuerzo en el asma inducido por el ejercicio en niños: estudio de la respuesta tardía.

In this study we perform the exercise broncho-provocation test according to a protocol and involving 27 children with allergic asthma to study the prevalence and distinctive traits of the late response in exercise-induced asthma (EIA). At the conclusion of the study, 20 patients (74%) were diagnosed of EIA through some of the tests employed (ergometric bicycle, free run). In the cases where both tests were negative, we reproduced in a controlled manner the exercise reported as asthmogenic on the basis of anamnesis; no positivity was observed for the test in any case. Prevalence of late asthmatic response was 40% (8/20); mean beginning time to this response was 4-6 hours, lasting less than 1 hour and with a mean intensity rate of 26.8% (measured as the percentage of PEFR drop according to the preexercise basal value). The results are discussed, comparing them with those of other authors and with the allergen provocation response pattern; in addition the methods used and therapeutic implications in view of the results are dealt with.

[Epidemiologic study of risk factors associated with the development of respiratory pathology in children]. / Estudio epidemiológico de los factores de riesgo asociados con el desarrollo de patología respiratoria en la población infantil.

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.

[Repercussion of risk factors associated with the development of chronic bronchial pathology on pulmonary function in children]. / Estudio de la repercusión de los factores de riesgo asociados al desarrollo de patología bronquial crónica en el funcionalismo pulmonar en una población infantil.

Of a total of 1,566 children, 1,416 of both sexes and aged 7 to 14 were subjected to functional respiratory exploration with a Vitalograph dry spirometer. The impact of tobacco smoke--as active and/or passive smokers--on the spirometric variables (FVC, FEV1, FEF2572, FEF50) evaluated by variance analysis (ANOVA) revealed no significant reductions. Asthma was the single antecedent of respiratory morbidity showing significant reductions in FEF2575, FEF50 among males alone; no significant reductions were observed for any of the other spirometric variables. No significant decreases were found in the spirometric variables on comparing two areas of the same city with the greatest difference in air pollution level.

[The role of IgA and IgA antigliadin antibodies in the diagnosis and management of celiac disease]. / Importancia de los anticuerpos antigliadina de tipo IgA e IgG en el diagnóstico y seguimiento de la E. celíaca.

The authors reports the results of ELISA IgG and IgA antigliadin antibodies measurements in a study of 271 serum samples proceeding from celiac patients (with and without gluten containing diet) and control subjects. IgA antigliadin antibody measurement had the most specificity and positive predictive value, IgG antigliadin antibody measurement had the most sensitivity and negative predictive value. Our results point out that antigliadin antibodies are helpful in the diagnosis and management of celiac disease. Un the same manner, antigliadin antibodies are helpful to evaluate the adherence of patients to gluten-free diet.

[Anti-endomysium antibodies: new serological markers for the diagnosis and follow-up of patients with gluten-sensitive enteropathy. Preliminary study]. / Anticuerpos antiendomisio: un nuevo marcador serológico para el diagnóstico y seguimiento de pacientes afectos de enteropatía sensible al gluten. Estudio preliminar.

The authors value the parameters of diagnostic efficacy in a preliminary study of anti-endomysium antibodies (EmA), in the diagnostic and follow-up of patients with gluten sensitive enteropathy. The study was made with 84 subjects distributed into four groups. Group I consisted of 21 patients with gluten sensitive enteropathy (GSE) who were eating gluten at the time of diagnosis. Group II consisted of 20 patients with gluten sensitive enteropathy with different periods of time of gluten free diet. Group III consisted of 16 subjects with non-evolutive neuropathies and without intestinal disease. This group was considered as controls. Group IV consisted of 27 patients with toddler diarrhoea. The sensitivity, specificity, positive predictive value, negative predictive value and efficiency were 100%.