Development of the web-based Spanish and Catalan versions of the Euroqol 5D-Y (EQ-5D-Y) and comparison of results with the paper version.

BACKGROUND: The objectives of the study were to develop web-based Spanish and Catalan versions of the EQ-5D-Y, and to compare scores and psychometric properties with the paper version. METHODS: Web-based and paper versions of EQ-5D-Y were included in a cross-sectional study in Palafolls (Barcelona), Spain and administered to students (n = 923) aged 8 to 18 years from 2 primary and 1 secondary school and their parents. All students completed both the web-based and paper versions during school time with an interval of at least 2 h between administrations. The order of administration was randomized. Participants completed EQ-5D-Y, a measure of mental health status (the Strengths and Difficulties Questionnaire), and sociodemographic variables using a self-administered questionnaire. Parents questionnaire included parental level of education and presence of chronic conditions in children. Missing values, and floor and ceiling effects were compared between versions. Mean score differences were computed for the visual analogue scale (VAS). Percentage of agreement, kappa index (k) and intraclass correlation coefficient (ICC) were computed to analyze the level of agreement between web-based and paper versions on EQ-5D-Y dimensions and VAS. Known groups validity was analyzed and compared between the two formats. RESULTS: Participation rate was 77 % (n = 715). Both formats of EQ-5D-Y showed low percentages of missing values (n = 2, and 4 to 9 for web and paper versions respectively), and a high ceiling effect by dimension (range from 79 % to 96 %). Percent agreement for EQ-5D-Y dimensions on the web and paper versions was acceptable (range 89 % to 97 %), and k ranged from 0.55 (0.48-0.61, usual activities dimension) to 0.75 (0.68-0.82, mobility dimension). Mean score difference on the VAS was 0.07, and the ICC for VAS scores on the two formats was 0.84 (0.82-0.86). Both formats showed acceptable ability to discriminate according to self-perceived health, reporting chronic conditions, and mental health status. CONCLUSIONS: The digital EQ-5D-Y showed almost identical VAS scores and acceptable levels of agreement on dimensions. Both formats demonstrated acceptable levels of construct validity. Availability of the Spanish and Catalan web-version will facilitate its use in HRQOL assessment and in economic evaluation.

Comparison of the web-based and paper [corrected] questionnaires of the Spanish and Catalan versionsof the KIDSCREEN-52.

BACKGROUND: The objectives of the study were to develop web-based Spanish and Catalan versions of the KIDSCREEN, and to compare scores and psychometric properties with the paper version. METHODS: Internet and paper Spanish and Catalan versions of the KIDSCREEN-52 were included in a cross-sectional study in school-age children. Web-based and paper Spanish or Catalan versions of the KIDSCREEN-52 were administered to students aged 8 to 18 years from primary and secondary schools in Palafolls (Barcelona, Spain, n = 923). All students completed both web-based and paper versions during school time with an interval of at least 2 hours between administrations. The order of administration was randomized. The KIDSCREEN-52, the Strengths and Difficulties Questionnaire (SDQ), and sociodemographic variables were collected. Missing values, floor and ceiling effects, and internal consistency were compared between both versions, as well as mean score differences, level of agreement, and known groups and construct validity. RESULTS: Participation rate was 77% (n = 715). Web-based and paper versions showed low percentage of missing values and similar high ceiling effect (range 0 to 44%). Mean score differences showed an effect size (ES) lower than 0.2 in all dimensions. Internal consistency ranged from 0.7 to 0.88, and degree of agreement was excellent (Intraclass correlation coefficient [ICC] range 0.75 to 0.87). Expected differences were seen by sex, age, socioeconomic status and mental health status. CONCLUSIONS: The web-based KIDSCREEN-52 showed similar scale score and reliability and validity than the paper version. It will incorporate the child population in the assessment of quality of life providing a more attractive format.

Contribution of immunological and virological factors to extremely severe primary HIV type 1 infection.

BACKGROUND: During acute human immunodeficiency virus (HIV) infection, high viral loads and the induction of host immune responses typically coincide with the onset of clinical symptoms. However, clinically severe presentations during acute HIV type 1 (HIV-1) infection, including AIDS-defining symptoms, are unusual. METHODS: Virus isolates were tested for clade, drug susceptibility, coreceptor use, and growth rate in 2 case reports of sexual transmission of HIV-1 infection. Human leukocyte antigen (HLA) genotype was determined, and HIV-1-specific cytotoxic T lymphocyte responses to an overlapping peptide set spanning the entire HIV clade A and clade B proteome were assayed. RESULTS: The viruses isolated in the 2 unrelated case reports of severe primary HIV-1 infection showed R5/X4 dual-mixed tropism, belonged to clade B and CRF02-AG, and were highly replicative in peripheral blood mononuclear cell culture. Impaired humoral responses were paralleled by a profound absence of HIV-1-specific cytotoxic T lymphocyte responses to the entire viral proteome in the 2 case reports. In 1 case report for which the virus source was available, there was a remarkable HLA similarity between the 2 patients involved in the transmission event, because 3 of 4 HLA-A and HLA-B alleles had matched HLA supertype for both patients. CONCLUSIONS: The data suggest that concurrence of viral and host factors contributes to the clinical severity of primary HIV-1 infection and that patients infected with highly replicative, dual-tropic viruses are more prone to develop AIDS-defining symptoms during acute infection if they are unable to mount humoral and cellular HIV-1-specific immune responses. The presence of concordant HLA supertypes might facilitate the preferential transmission of HLA-adapted viral variants, further accelerating disease progression.

Pancreatitis aguda secundaria a colelitiasis en una niña con síndrome de Down / Acute pancreatitis due to cholelithiasis in a girl with Down Syndrome

La litiasis biliar en pediatría es una entidad poco frecuente y generalmente asintomática; sin embargo, puede ser potencialmente grave en los casos en que desencadena una pancreatitis como complicación. Trabajos publicados recientemente indican una mayor prevalencia de la litiasis biliar en niños con síndrome de Down (SD). Presentamos el caso de una niña con SD que presenta una pancreatitis aguda secundariamente a una colelitiasis que se resuelve satisfactoriamente (AU)

Gallstones are infrequent in children, and usuallya symptomatic. However, complications can besevere if pancreatitis ensues. Recent reports indicate above-average prevalence of cholelithiasis in Down syndrome. We report the successfully treated case of a 7-year-old girl with Down syndrome who developed pancreatitis secondary to cholelithiasis (AU)

Procalcitonin, C-reactive protein and leukocyte count in children with lower respiratory tract infection.

BACKGROUND: Lower respiratory tract infection is the most common infection leading to unnecessary antibiotic treatment in children. Etiologic diagnosis is not immediately achieved, and the pathogen remains unidentified in a large number of cases. Neither clinical nor laboratory factors allow for a rapid distinction between bacterial and viral etiology. The aim of our study was to evaluate the reliability of procalcitonin (PCT), C-reactive protein (CRP) and leukocyte count in distinguishing pneumococcal, atypical and viral lower respiratory tract infection. METHODS: PCT, CRP and leukocyte count were measured in children with microbiologically documented diagnoses of lower respiratory tract infection. The results were compared of children with pneumococcal, atypical and viral etiologies. RESULTS: PCT and CRP showed significant correlation with a bacterial etiology of lower respiratory tract infection. No significance was found for leukocyte count. Using a cutoff point of 2 ng/ml for PCT and 65 mg/l for CRP, the sensitivities and specificities for distinguishing bacterial from viral lower respiratory tract infections were 68.6 and 79.4% for PCT and 79.1 and 67.1% for CRP. The sensitivities and specificities for distinguishing pneumococcal from other etiologies were 90.3 and 74.1% for PCT and 90.3 and 60% for CRP, respectively. CONCLUSIONS: High PCT and CRP values show a significant correlation with the bacterial etiology of lower respiratory tract infection. PCT and CRP show good sensitivity for distinguishing pneumococcal from other etiologies. PCT shows higher specificity than CRP. PCT and CRP can help make decisions about antibiotic therapy in children with lower respiratory tract infections.

Elevated serum procalcitonin values correlate with renal scarring in children with urinary tract infection.

BACKGROUND: Urinary tract infection (UTI) in young children carries the risk of parenchymal damage and sequelae. The location of the infection within the urinary tract influences decisions regarding both therapeutics and follow-up. Because clinical features and laboratory markers of infection at an early age are not specific, it is difficult to make a distinction between lower UTI and acute pyelonephritis. Procalcitonin (PCT) has been studied as a marker of severe bacterial infection. The aim of this study was to test the usefulness of PCT concentration in serum to distinguish between uncomplicated UTI and severe acute pyelonephritis with renal scars. METHODS: PCT was measured by immunoluminometric assay in serum samples from children with microbiologically documented infection. Severe renal involvement was assessed by 99mTc-dimercaptosuccinic acid gammagraphy done 5 to 6 months after the episode to check for the presence of parenchymal scars. C-reactive protein (CRP) and leukocyte count were also measured. RESULTS: PCT at presentation showed a significant correlation (P < 0.001) with the presence of renal scars in children with UTI. Using a cutoff of 1 ng/ml for PCT and 20 mg/l for CRP, sensitivity and specificity in distinguishing between urinary tract infection with and without renal damage were 92.3 and 61.9%, respectively, for PCT and 92.3 and 34.4% for CRP. Positive and negative predictive values were 32 and 97.5%, respectively, for PCT and 23 and 95%, respectively, for CRP. CONCLUSIONS: A low PCT value at admission indicates a low risk of long term renal scarring. Increased PCT values at admission correlate with the presence of scars. PCT values have proved to be more specific than CRP and leukocyte count for identifying patients who might develop renal damage.

Nen de 4 anys d’origen gambià que en tornar del seu país d’origen desenvolupa una tumoració a l’extremitat inferior / No disponible

No disponible