Asociación entre neuroimagen y secuelas neurológicas en pacientes con infección congénita por citomegalovirus / Association between neuroimaging findings and neurological sequelae in patients with congenital cytomegalovirus infection

Introducción: La infección congénita por citomegalovirus (CMV) supone una importante causa de discapacidad. Existen escasas evidencias acerca del valor pronóstico de las lesiones presentes en los estudios de neuroimagen. Objetivo: Analizar la gravedad de las lesiones en la resonancia magnética (RM) y la ecografía transfontanelar, y su relación con déficits neurológicos a largo plazo. Pacientes y métodos: Se realizó un estudio observacional analítico retrospectivo de 36 pacientes con infección congénita por CMV. Se revisaron los estudios de neuroimagen y se clasificaron según la escala de Noyola et al. modificada. Se relacionaron los hallazgos de neuroimagen con la afectación neurológica en su última visita en la consulta de neuropediatría. Resultados: Un total de 36 pacientes fueron estudiados, habiéndose realizado ecografía transfontanelar en 30 y RM cerebral en 29. La ecografía transfontanelar estuvo alterada en 20/30 pacientes, de los cuales, 11 tuvieron alteración en la RM (p = 0,04) y 10 afectación neurológica (p = 0,008). Tuvo una sensibilidad del 83,3%, IC 90%: 58-100 y una especificidad del 44,4%, IC 90%: 18,7-70,2 para la predicción de secuelas neurológicas. La RM estuvo alterada en 20/29 pacientes. Dieciséis de ellos tuvieron afectación neurológica (p < 0,001), teniendo una sensibilidad del 94%, IC 95%: 80-100 y una especificidad del 66,6%, IC 95%: 36-97,5 para la predicción de secuelas neurológicas. Una escala de Noyola et al. ≥ 2 se asoció a retraso psicomotor (p < 0,001). Conclusión: Nuestro trabajo valida los estudios previos en los que se encuentra correlación estadísticamente significativa entre la extensión de las lesiones en neuroimagen y la gravedad de los déficits neurológicos. (AU)

Background: Congenital cytomegalovirus (CMV) infection is an important cause of disability. There is little evidence on the prognostic value of lesions identified in neuroimaging studies. Aim: The study aimed to assess the severity of lesions detected with brain MRI and transfontanellar ultrasound and their relationship with long-term neurological deficits. Patients and methods: We performed a retrospective, analytical, observational study of 36 patients with congenital CMV infection. Neuroimaging studies were reviewed and classified according to the modified Noyola’ scale. Imaging findings were compared with neurological alterations in the patients’ most recent follow-up evaluation at the paediatric neurology department. Results: Thirty-six patients were studied (transfontanellar ultrasound: 30; brain MRI: 29). Twenty of 30 patients showed ultrasound abnormalities; of these, 11 showed alterations on brain MR images (P=.04) and 10 had neurological impairment (P=.008). Transfontanellar ultrasound had a sensitivity of 83.3%, 90% CI: 58-100 and a specificity of 44.4%, 90% CI: 18.7-70.2 for predicting neurological sequelae. Brain MRI displayed abnormalities in 20 of 29 patients, of whom 16 had neurological impairment (P<.001). MRI had a sensitivity of 94%, 95% CI: 80-100 and a specificity of 66.6%, 95% CI: 36-97.5 for predicting neurological sequelae. Modified Noyola’ scale values >2 were correlated with psychomotor retardation (P<.001). Conclusions: Our findings validate previous studies reporting a statistical significant correlation between the extension of neuroimaging lesions and severity of neurological deficits. (AU)

Association between neuroimaging findings and neurological sequelae in patients with congenital cytomegalovirus infection.

BACKGROUND: Congenital cytomegalovirus (CMV) infection is an important cause of disability. There is little evidence on the prognostic value of lesions identified in neuroimaging studies. AIM: The study aimed to assess the severity of lesions detected with brain MRI and transfontanellar ultrasound and their relationship with long-term neurological deficits. PATIENTS AND METHODS: We performed a retrospective, analytical, observational study of 36 patients with congenital CMV infection. Neuroimaging studies were reviewed and classified according to the modified Noyola' scale. Imaging findings were compared with neurological alterations in the patients' most recent follow-up evaluation at the paediatric neurology department. RESULTS: Thirty-six patients were studied (transfontanellar ultrasound: 30; brain MRI: 29). Twenty of 30 patients showed ultrasound abnormalities; of these, 11 showed alterations on brain MR images (P = .04) and 10 had neurological impairment (P = .008). Transfontanellar ultrasound had a sensitivity of 83.3%, 90% CI: 58-100 and a specificity of 44.4%, 90% CI: 18.7-70.2 for predicting neurological sequelae. Brain MRI displayed abnormalities in 20 of 29 patients, of whom 16 had neurological impairment (P < .001). MRI had a sensitivity of 94%, 95% CI: 80-100 and a specificity of 66.6%, 95% CI: 36-97.5 for predicting neurological sequelae. Modified Noyola' scale values > 2 were correlated with psychomotor retardation (P < .001). CONCLUSIONS: Our findings validate previous studies reporting a statistical significant correlation between the extension of neuroimaging lesions and severity of neurological deficits.

Association between neuroimaging findings and neurological sequelae in patients with congenital cytomegalovirus infection. / Asociación entre neuroimagen y secuelas neurológicas en pacientes con infección congénita por citomegalovirus.

BACKGROUND: Congenital cytomegalovirus (CMV) infection is an important cause of disability. There is little evidence on the prognostic value of lesions identified in neuroimaging studies. AIM: The study aimed to assess the severity of lesions detected with brain MRI and transfontanellar ultrasound and their relationship with long-term neurological deficits. PATIENTS AND METHODS: We performed a retrospective, analytical, observational study of 36 patients with congenital CMV infection. Neuroimaging studies were reviewed and classified according to the modified Noyola' scale. Imaging findings were compared with neurological alterations in the patients' most recent follow-up evaluation at the paediatric neurology department. RESULTS: Thirty-six patients were studied (transfontanellar ultrasound: 30; brain MRI: 29). Twenty of 30 patients showed ultrasound abnormalities; of these, 11 showed alterations on brain MR images (P=.04) and 10 had neurological impairment (P=.008). Transfontanellar ultrasound had a sensitivity of 83.3%, 90% CI: 58-100 and a specificity of 44.4%, 90% CI: 18.7-70.2 for predicting neurological sequelae. Brain MRI displayed abnormalities in 20 of 29 patients, of whom 16 had neurological impairment (P<.001). MRI had a sensitivity of 94%, 95% CI: 80-100 and a specificity of 66.6%, 95% CI: 36-97.5 for predicting neurological sequelae. Modified Noyola' scale values >2 were correlated with psychomotor retardation (P<.001). CONCLUSIONS: Our findings validate previous studies reporting a statistical significant correlation between the extension of neuroimaging lesions and severity of neurological deficits.

Sección de Oncología y Hematología Pediátricas del Hospital General Universitario Gregorio Marañón / Pediatric Oncology and Hematology Area of the Hospital General Universitario Gregorio Marañón

La Unidad de Oncología y Hematología Infantil del Hospital Gregorio Marañón comenzó su andadura en los años 70, presentando desde entonces un crecimiento progresivo y una modernización acorde con la evolución de la propia especialidad. En esta monografía se describe la organización de la sección, así como los recursos estructurales, las características del trabajo asistencial, la actividad docente e investigadora y la participación en diversos grupos de trabajo colaborativos o multidisciplinares. Se destaca la capacidad de abordaje integral de este tipo de patologías en todas las fases de las mismas, desde el diagnóstico al tratamiento, sin Olvidar el aspecto psicosocial o la atención paliativa en su fase terminal, si fuera necesario. En conjunto, se dibuja un cuadro que es una obra coral de muchos profesionales sanitarios (personal médico, psicooncología, enfermería, auxiliares...) y no sanitarios, pero cuyo tema principal es proporcionar la mejor asistencia posible al niño y a su familia (AU)

The Pediatric Oncology and Hematology Unit at the Gregorio Marañón Children's Hospital began its activity in the 705, presenting since then a progressive growth and modernization in accordance with the evolution of the specialty itself… In this paper we describe the organization of the section, our structural resources, the characteristics of care work, teaching and research activities and our participation in various collaborative or multidisciplinary work groups. It is remarkable the ability to comprehensively address this type of pathologies in its different phases, from diagnosis to treatment, without forgetting to mention the psychosocial aspect or palliative care in its terminal phase, if necessary. Altogether, a choral picture is drawn with the work of many health professionals (medical, psycho-oncology, nursing, assistants …) and non—health, but the main theme is to provide the best care for the child and his family (AU)

Aislamiento de Clostridium difficile en niños hospitalizados con diarrea / Clostridium difficile isolation in children hospitalized with diarrhea

Introducción: Clostridium difficile es la principal causa de diarrea nosocomial en adultos, y su incidencia está aumentado en los últimos años. Es difícil determinar su impacto en niños debido a las altas tasas de colonización. Material y métodos: Estudio retrospectivo en menores de 15 años ingresados con diarrea a lo largo de un año. Se estudiaron las características epidemiológicas, clínicas, analíticas y la evolución de los niños con infección por Clostridium difficile (ICD) en comparación con otros aislamientos. Los factores predictores de ICD fueron determinados mediante análisis multivariante. Resultados: Se identificaron 250 niños con diarrea, realizándose estudio microbiológico completo en 174. En 79 (45,4%) se llegó al diagnóstico: 25,6% ICD (n=19; 13 enterotoxigénicos); 28,6% otras bacterias (n=21) y 45,8% virus (n=34; rotavirus n=31; adenovirus n=3). Un 68,4% fueron menores de 2 años, y un 15,8% fueron adquiridos en la comunidad. En comparación con otras causas de diarrea, la ICD se asoció a comorbilidad (p<0,0001), contacto reciente con el sistema sanitario (p<0,0001), estancia en UCI (p=0,003) y exposición reciente a antibióticos (p<0,0001). Los pacientes con ICD cursaron de forma oligosintomática. No hubo diferencias clínicas entre las ICD productoras o no de toxina, siendo la comorbilidad el principal asociado con la ICD (OR 40,02; IC 95% 6,84-232,32; p<0,0001). Conclusiones: El aislamiento de Clostridium difficile es frecuente en niños hospitalizados con diarrea en nuestro medio. La ICD resultó más frecuente en niños pequeños con comorbilidad y contacto reciente con el sistema sanitario, presentado, en su mayoría, un curso clínico oligosintomático. Se necesitan más estudios para conocer la epidemiología de esta infección en niños (AU)

Introduction: Clostridium difficile is the leading cause of nosocomial and antibiotic-associated diarrhea in adults, and its incidence has substantially risen over the last few years. The prevalence of this infection in children is difficult to assess due to the high rates of colonization in this setting. Material and methods: A one-year retrospective study was conducted on children under 15 years admitted to hospital with acute diarrhea. Epidemiological, clinical, laboratory findings and outcome of children with Clostridium difficile infection (CDI) were compared to other causes of diarrhea. Risk factors for CDI were identified by multivariate analysis. Results: Two hundred and fifty children with acute diarrhea were identified. A microbiological pathogen was identified in 79 (45.4%) of 174 patients who underwent complete testing: 19 CDI (25.6%, 13 of which were enterotoxin-producing), 21 other bacteria (28.6%), and 34 viruses (45.8%; rotavirus n=31; adenovirus n=3). The estimated incidence of CDI was 3 cases/1,000 admissions, with 68.4% of them occurring in children younger than 2 years. Overall, 15.8% were community-acquired. Compared to other causes of diarrhea, CDI was associated with comorbidity (P<.0001), recent contact with the health-care system (P<.0001) or intensive care unit stay (P=.003) and exposure to antibiotics in the previous month (P<.0001). The clinical course of children with CDI was less symptomatic. There were no clinical differences between Clostridium difficile toxin-producers and non-toxin producers. Comorbidity was identified as the main risk factor associated with CDI (OR 40.02, 95% CI 6.84-232.32; P<.0001). Conclusions: The isolation of Clostridium difficile is common in hospitalized children with diarrhea in our setting. CDI is more frequent in children with comorbidity and recent contact with the health-care system, presenting a mostly oligosymptomatic clinical course. Further studies are needed to understand the epidemiology of this infection in pediatrics, especially the percentage of asymptomatic carriers (AU)

[Clostridium difficile isolation in children hospitalized with diarrhea]. / Aislamiento de Clostridium difficile en niños hospitalizados con diarrea.

INTRODUCTION: Clostridium difficile is the leading cause of nosocomial and antibiotic-associated diarrhea in adults, and its incidence has substantially risen over the last few years. The prevalence of this infection in children is difficult to assess due to the high rates of colonization in this setting. MATERIAL AND METHODS: A one-year retrospective study was conducted on children under 15 years admitted to hospital with acute diarrhea. Epidemiological, clinical, laboratory findings and outcome of children with Clostridium difficile infection (CDI) were compared to other causes of diarrhea. Risk factors for CDI were identified by multivariate analysis. RESULTS: Two hundred and fifty children with acute diarrhea were identified. A microbiological pathogen was identified in 79 (45.4%) of 174 patients who underwent complete testing: 19 CDI (25.6%, 13 of which were enterotoxin-producing), 21 other bacteria (28.6%), and 34 viruses (45.8%; rotavirus n=31; adenovirus n=3). The estimated incidence of CDI was 3 cases/1,000 admissions, with 68.4% of them occurring in children younger than 2 years. Overall, 15.8% were community-acquired. Compared to other causes of diarrhea, CDI was associated with comorbidity (P<.0001), recent contact with the health-care system (P<.0001) or intensive care unit stay (P=.003) and exposure to antibiotics in the previous month (P<.0001). The clinical course of children with CDI was less symptomatic. There were no clinical differences between Clostridium difficile toxin-producers and non-toxin producers. Comorbidity was identified as the main risk factor associated with CDI (OR 40.02, 95% CI 6.84-232.32; P<.0001). CONCLUSIONS: The isolation of Clostridium difficile is common in hospitalized children with diarrhea in our setting. CDI is more frequent in children with comorbidity and recent contact with the health-care system, presenting a mostly oligosymptomatic clinical course. Further studies are needed to understand the epidemiology of this infection in pediatrics, especially the percentage of asymptomatic carriers.

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Productos homeopáticos: la importancia de una correcta información / Homeopathic products: The importance of correct information

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Diagnóstico prenatal y manejo del quiste broncogénico / Prenatal diagnosis and management of bronchogenic cyst

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Psoriasis inducida por infliximab en una adolescente con colitis ulcerosa / Infliximab-induced psoriasis in an adolescent with ulcerative colitis

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