Protocolo de actuación en atención primaria en la enfermedad inflamatoria intestinal en la edad pediátrica / Protocol of action in primary care in the pediatric inflammatory bowel disease

Dadas las características de la enfermedad inflamatoria intestinal de los pacientes pediátricos y las diferencias clínicas, es muy importante realizar un diagnóstico y tratamiento lo más precoz posible. El retraso en el inicio del tratamiento implica una menor respuesta al mismo y una evolución hacia una mayor gravedad. El trabajo conjunto desde los centros de salud y los niveles hospitalarios siempre resulta beneficioso para el paciente, a la vez que ayuda y acerca a los profesionales. En la literatura médica no se han documentado muchos protocolos dirigidos al diagnóstico precoz y el manejo de esta patología en pacientes pediátricos en atención primaria en coordinación con la atención hospitalaria

An early diagnosis and treatment in the pediatric inflammatory bowel disease is essential. Pediatric patients have special age-related features that make them different to de adults. Delayed beginning treatment implies a lower response and evolution towards a higher severity. A delayed treatment implies lower response and a worse illness outcome. Coordination between primary health care and tertiary care centers is mandatory to benefit the patients and to get better outcomes. This approach in the pediatric patients is not described in scientific papers

Valoración del estudio alérgico en niños con atopia / Allergic study assessment in atopic children

Introducción: la atopia se define como la tendencia a producir anticuerpos IgE específicosfrente a alérgenos y se expresa clínicamente como dermatitis-eccema, asma y rinoconjuntivitis. En los últimos años se ha documentado el aumento de la prevalencia de atopia en los países desarrollados. La detección de los alérgenos implicados es necesaria para unas medidas terapéuticasóptimas.El objetivo del estudio es describir el perfil de sensibilizaciones en los niños con atopia delmunicipio de Zaragoza. Material y métodos: durante el verano de 2009 se revisaron las historias clínicas de los niñosde 0-14 años, de las consultas de 6 pediatras de Atención Primaria. Se obtuvo una muestrade 194 niños con clínica y estudio alérgico positivo en los últimos 5 años. Resultados: distribución por sexo: 62,9% varones y 37,1% mujeres. Hallazgos clínicos: asma:78%, rinitis: 68%, conjuntivitis: 50% y dermatitis: 29%; con frecuencia se asociaron diferentes diagnósticos. Los alérgenos positivos fueron: gramíneas: 48%, hongos: 35%, árboles: 34%, animales: 26%, alimentos: 24%, ácaros: 19% y malezas: 18%. Conclusiones: las causas más importantes de sensibilización en nuestro estudio son primerolas gramíneas y luego la Alternaria; olivo, animales, ácaros y malezas les siguen por este orden.En nuestra zona geoclimática, si hay síntomas en invierno o al final del verano se debe estudiarel ciprés, plátano de sombra, Chenopodium y Salsola. La alta sensibilización a alimentosencontrada se corresponde con otros estudios. La identificación de las sensibilizaciones permiterelacionarlas con la clínica, tomar las medidas terapéuticas oportunas y mejorar la calidad de vidade los niños (AU)

Introduction: atopy is defined as the tendency to produce allergen-specific IgE antibodiesand is expressed clinically as dermatitis, eczema, bronchial asthma and rhino-conjunctivitis. Inthe last years, an increased prevalence of atopy in developed countries has been documented.The detection of allergens involved is necessary for optimal therapeutic measures. The aim ofthis study is to describe the profiles of sensitizations in children with atopy in the municipalityof Zaragoza.Material and methods: in the summer of 2009 the clinical histories of 0-14 year-old children,of 6 pediatricians’ consultations were reviewed. A sample of 194 children with clinicalfindings and allergic positive study in the last 5 years was collected.Results: distribution between sexes: 62.9% male and 37.1% female. Clinical findings:78% asthma, 68% rhinitis, 50% conjunctivitis and 29% dermatitis; often several diagnoseswere associated. The allergens found were: 48% gramineae, 35% fungi, 34% trees, 26% animals,24% food, 19% dust-mites and 18% weeds.Conclusions: the most important causes of sensitization in our study are gramineae in thefirst place followed by Alternaria. Olive tree, animals, dust-mites and weeds follow them in thisorder. We must study cypress, platanus orientalis and Chenopodium, and Salsola, which areprevalent in our geoclimatic zone, if there are symptoms in winter or in late summer. The high sensitization to food matches other studies. The identification of the sensitizations will allow usto relate them to the clinic, take the appropriate therapeutic measures and to improve the quality of life of these children (AU)

Hipercalciuria idiopática en atención primaria: a propósito de tres casos / Idiopathic hypercalciuria in Primary Health Care: Three cases report

La hipercalciuria idiopática es un cuadro clínico frecuente que a nuestro parecer podría estar infradiagnosticado dada su clínica tan inespecífica y la escasa literatura existente sobre el mismo. Para su diagnóstico se requiere pruebas complementarias accesibles al médico de Atención Primaria por lo que debería ser a este nivel desde donde se diagnosticaran la mayor parte de estos casos (AU)

[Prognosis in recurrent peripheral idiopathic facial paralysis in childhood]. / Pronóstico de la parálisis facial periférica idiopática y recidivante en la infancia.

Fifty-nine cases of idiopathic peripheral facial palsy were diagnosed in our unit during the period from January 1, 1984 to December 31, 1989. During follow-up examinations we observed a relapse in eleven cases, corresponding to 18.6% of the patients. Nine patients suffered a relapse once, one case twice and another case four times. The children that presented more than one recurrence have later shown functional sequelae, both clinical and neurophysiological. We conclude that in our series of patients relapse of facial palsy is a factor that worsens the prognosis for recovery. Furthermore, the existence of facial palsy in the family history leads to a greater risk of a recurrence.

[Lymphoblastic non-Hodgkin's lymphoma: estimation of the survival of patients with the disseminated form of the disease (stages III and IV) treated by the LSA2-L2 protocol]. / Linfoma no Hodgkin de tipo linfoblástico: evaluación de la supervivencia en pacientes con enfermedad diseminada (estadío III y IV) tratados con el protocolo LSA2-L2.

We analyze the survival rate in 17 pediatric patients (twelve males and five females) that were diagnoses of non-Hodgkin's lymphoblastic lymphoma (cases with Burkitt's lymphoma were excluded) during the period from 1982 to 1990. All of them were treated using the LSA2-L2 therapeutic protocol. The follow-up period ranged from 14 to 99 months (follow-up median 43 months). Staging of our newly diagnosed patients, we found 9 patients in stage III and 8 in stage IV disease. Survival was analyzed by the Kaplan-Meier method. The overall survival rate of our patients is 69.5% and the disease free survival is 62.6%. The disease free survival for separated stages is 66.5% for stage III and 58.3% for stage IV. We compare our results with other casuisties published in literature.

[Accidents in childhood: apropos of 14,301 cases treated in the course of one year]. / Accidentes en la infancia: a propósito de los 14.301 casos atendidos durante 1 año.

The present study aims: to revise all the cases of paediatric accidents attended at a Emergency Service of a tertiary Hospital; to analyze the epidemiological variables; and to try to draw conclusions in view of prevention. In order to achieve that, the 14.301 accidents attended during 1989 have been collected. The relation between little boys and little girls is 58.2:41.8. The average age is 7.12 years, though the mode has been 2 years. A larger number of accidents occur during non holiday. 44.3% of cases are attended between 18 and 23 hours. 89% of the accidents are, first of all, traumatisms and/or wounds; secondly, those which are produced by strange bodies (4.4%). In 51.9% of cases no complementary trial was carried out. Only 2.9% of cases were admitted to hospital, whereas 104% requires observation, and the rest returns home. The variables in the admitted patients are also analyzed, and a brief exposition of results for each of the 6 diagnostic groups is made.

[Tuberculosis: epidemiologic and clinical study of 268 pediatric patients]. / Tuberculosis: estudio epidemiológico y clínico de 268 pacientes en edad infantil.

TBC begins to be a big health problem at this moment. It was achieved a retrospective study with 238 cases in infant age, entered at Infections Section of Children's Hospital "Miguel Servet" of Zaragoza, during 18 years (1972-1989) studying epidemiologic and clinic factors. We divided in two groups: the first, latent disease (TBC turn) and the second, patent disease. The found incidence was 0.17%. The most affected group were among 0-5 years old (39.075%) of whom 53.76% were male. It was a little prevalence during winter and spring months. The middle-drop social class were the most affected. The epidemiologic ambient was positive in 31.4%. Only were vaccinated 33.6% of children. We observed more clinic forms among nonvaccinated. The lung-form (59.6%) and pleurisy (14.2%) were the most frequent found forms. The less frequent form was miliary TBC (0.96%). The parenquimatosa infiltration was the most frequent found form (42.5%).