Quality of life against seasonal vs perennial allergens: ESPRINT-15 modified in the pediatric population

Introduction: Allergic rhinitis (AR) is a clinical syndrome characterized by IgE-mediated inflam-mation of the nasal mucosa. The present study investigates the quality of life (QoL) with AR among adults, using widely validated questionnaires, unlike in pediatric patients.Materials and methods: A cross-sectional descriptive observational study was conducted, analyzing the QoL of 102 children with AR aged between 10-15 years, belonging to two health centers (HC) in Zaragoza and two HC in Coruña. The comparison of means between the two groups is carried out using the Student's test or the Mann-Whitney test, considering a value of p<0.05 to be significant.Results: Around 102 children were studied, with a majority (59.8%) being male and a mean age of 12 years. Around 76.5% have a family history of atopy. It was found that AR is more prevalent in Zaragoza (p <0.005), and asthmais highly prevalent in Coruña (p <0.001). The most import-ant sensitizations are pollen in Zaragoza (p <0.05) and dust mites in A Coruña (p <0.001). More treatment needs and associated comorbidities (p<0.05) were observed in A Coruña. The results of the ESPRINT-15 show that 63% of the patients have a good QoL, 27% fair, and 8.8%, poor. Those sensitized to mites have a worse score (p = 0.02). It was found that 52% of children expe-rienced improvement during home confinement, with no notable differences between the two populations. The use of the mask favored QoL in patients from Zaragoza (p <0.0 01 (AU)

Seguimiento en las consultas de Pediatría de Atención Primaria de los grandes prematuros: nacidos con menos de 32 semanas de gestación o menos de 1500 gramos / Follow-up in Primary Care Pediatric consultations of very premature babies: born at less than 32 weeks' gestation or weighing less than 1500 grams

Introducción: casi un 20% de los grandes prematuros abandona el seguimiento en los hospitales y tienen peor evolución que los que continúan el programa. Obtener datos sobre la implicación de los pediatras de Atención Primaria (PAP) en el seguimiento del prematuro de menos de 32 semanas o con peso < 1500 g es necesario para plantear estrategias de mejora. Material y métodos: estudio observacional, transversal, descriptivo, en el ámbito de las 17 comunidades autónomas españolas, a través PAPenRED (304 PAP). Se recogieron datos mediante encuestas cumplimentadas online acerca del número de grandes prematuros por pediatra, el tipo de seguimiento y las dificultades en su atención. Se describen las distribuciones de frecuencias, en porcentajes, de las variables cualitativas. Resultados: se incluyeron 870 grandes prematuros con una media por pediatra de 3,8. El 68,84% de los PAP no tienen programa común de seguimiento para el hospital y Atención Primaria (AP), y al 99% les gustaría tenerlo. El 84,27% manifiesta que estos niños tienen problemas más complejos y las patologías que presentan con mayor frecuencia en comparación con los nacidos a término son: la ansiedad familiar, la patología respiratoria y los problemas relacionados con el crecimiento, la alimentación, el desarrollo motor y los cognitivos y del comportamiento. Conclusiones: los PAP creen necesarios los programas conjuntos hospital-AP para el seguimiento de los grandes prematuros (AU)

Introduction: almost 20% of premature babies abandons the follow-up in hospitals and they have worse outcomes than those who continue the program. Obtaining data on the involvement of Primary Care pediatricians (PAPs) in monitoring premature babies born at less than 32 weeks or weighing less than 1500 g is necessary to propose strategies for improvement. Methods: it is an observational, transversal, descriptive study, in the area of ​​the 17 Spanish autonomous communities, through PAPenRED network (304 PAPs). Data were collected by questionnaires filled out online about the number of premature babies by pediatrician, the type of monitoring and the difficulties found in their attention. Frequency distributions, percentages, qualitative variables are described. Results: 870 very premature infants were included with an average of 3.8 per pediatrician. 68.84% of PAPs do not share a common monitoring program between hospitals and Primary Care centers, despite the fact that 99% of the pediatricians would like to have it. 84.27% say that these children have more complex problems. The diseases that occur more frequently compared to those born at term are family anxiety, respiratory disease and problems in relation to growth, feeding, motor development and cognitive and behavioral issues. Conclusions: PAPs believe necessary commmon programs between hospitals and Primary Care centers for monitoring the very premature babies (AU)

Alivio del dolor y el estrés al vacunar. Síntesis de la evidencia. Recomendaciones del Comité Asesor de Vacunas de la AEP / Relief of pain and distress during immunizations. Synthesis of evidence. Recommendations of the Advisory Committee on Vaccines of the Spanish Association of Paediatrics

Introducción: en niños y adolescentes sanos, las vacunaciones son con frecuencia fuente de dolor y sufrimiento. Padres, niños, adolescentes y profesionales sanitarios muestran preocupación sobre ello. El Comité Asesor de Vacunas de la Asociación Española de Pediatría (CAV-AEP) cree que abordar el dolor y el sufrimiento al vacunar es necesario, siguiendo la metodología de la medicina basada en la evidencia. El objetivo del presente trabajo es elaborar recomendaciones basadas en el conocimiento científico. Material y métodos: se dividió la materia de estudio en cuatro áreas: amamantamiento y soluciones azucaradas, anestésicos tópicos, métodos para la administración de vacunas y otras intervenciones (distracción). Se realizó una síntesis de la evidencia, asumiendo las recomendaciones de la Guía de práctica clínica de Anna Taddio (2010) e incorporando la evidencia de revisiones sistemáticas y ensayos clínicos posteriores a los incorporados en dicha guía. Resultados: las medidas que se han mostrado efectivas en la disminución del dolor han sido las siguientes: en lactantes, amamantar antes, durante y después de la inyección; las soluciones azucaradas son una alternativa si la lactancia materna no fuera posible; los anestésicos tópicos son eficaces para todas las edades, pero requieren un tiempo para mostrar su efecto y tienen un coste; no aspirar en la inyección intramuscular y hacerlo lo más rápido posible; administrar las vacunas de forma que la más dolorosa sea la última; cuando sea posible, es preferible inyectar simultáneamente más de una vacuna que hacerlo de forma secuencial; sostener al niño en brazos; y utilizar maniobras de distracción para niños de 2-14 años. Conclusiones: realizada una exhaustiva revisión del tema, hay pruebas suficientes para afirmar que los profesionales que administran vacunas infantiles deberían poner en práctica medidas para atenuar el dolor que indudablemente acompaña al procedimiento de la vacunación. Se trata además, en general, de medidas técnicamente sencillas y fáciles de incorporar a la práctica (AU)

Background: in healthy children and adolescents, immunizations that require a needle related procedure are the most common source of pain and distress. Parents, children, adolescents and health-care providers are concerned about this. The Advisory Committee on Immunization of the Spanish Association of Pediatrics (CAV-AEP) believes that address pain and distress at the time of vaccination is necessary following recommendations that have to be based on rigor and science. Methods: we divided the subject in four areas: Breastfeeding and oral sucrose solutions, topical anaesthetics, vaccination administration methods and other interventions (distraction). Synthesis of evidence was made. Assuming the recommendations of The Clinical Guideline of Anne Taddio (2010) and adding the evidence of clinical trial published after the Guide. Results: methods that showed effectiveness in diminishing pain were: for infants, breastfeeding before, during and after the puncture is effective in manage pain. Oral sucrose solutions could be an alternative if breastfeeding is not possible. Topical anaesthetics are effective for all ages but a time to produce effect is required and need financial resources. No aspiration for intramuscular injection, put the injection as quickly as possible, give the vaccines so that the most painful the last. If more than one vaccine injection are required in the same visit, and it is possible, it is preferable to inject simultaneously more than one vaccine than sequentially. Hold the infant. For children 2 to 14 years use distraction techniques. Conclusions: as a thorough revision of the topic was made, there are enough evidence to recommend that in any setting where children immunization is given, techniques to mitigate pain at the time of vaccination should be implemented, moreover these strategies are simple and easy to assimilate in clinical practice (AU)

Test de detección rápida en infecciones ORL y respiratorias: utilidad en la consulta / Rapid tests in otolaryngologic and respiratory tract infections: usefulness in the medical office

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Abordaje del trastorno por déficit de atención con/sin hiperactividad desde la visión del pediatra de cabecera. Presentación / Attention Deficit Hyperactivity Disorder’s approach, the primary care pediatrician’s view. Presentation

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Estado de portador de neumococo en niños y su relación con la enfermedad invasiva. ¿Qué ha cambiado tras la introducción de la vacuna conjugada? / The state of pneumoccci asymptomatic carrier in children and its relation to the invasive disease. What has changed after the conjugated vaccine introduction?

En la última década se han sucedido cambios importantes relativos a la enfermedad neumocócica invasiva (ENI) en los países desarrollados. Con la generalización de la vacuna neumocócica conjugada heptavalente (VNC-7), se ha constatado la efectividad de la vacuna para disminuir la ENI por los serotipos incluidos en dicha vacuna (STV), pero también han surgido nuevos serotipos no incluidos y que han emergido con fuerza como productores de ENI. Afortunadamente, la carga de la enfermedad invasiva ahora provocada por los no vacunales en niños menores de cinco años es sensiblemente menor que la que provocaron los STV en la era prevacunal, y esta tendencia parece estable en el tiempo. Pero este proceso se ha seguido en paralelo por cambios similares en la colonización nasofaríngea por neumococos, muy frecuente en niños menores de cinco años, de manera que en la actualidad los STV han disminuido radicalmente en portadores sanos, y han sido sustituidos por no vacunales que terminan produciendo ENI. Este reemplazo de serotipos ha tenido también como consecuencia que las resistencias a antibióticos hayan descendido, ya que estas eran más prevalentes entre los STV. Recientemente se han comercializado dos nuevas vacunas conjugadas que amplían la protección a nuevos serotipos. Este artículo pretende repasar los cambios que se han producido y las expectativas e incertidumbres que se abren en esta nueva etapa de las vacunas neumocócicas conjugadas(AU)

Reacciones adversas psiquiátricas asociadas a nuevos macrólidos. A propósito de tres casos / Psychiatric adverse reactions associated to new macrolides. Three case reports

Los macrólidos representan el 10-15% del mercado mundial de antibióticos orales. Son uno de los grupos de antibióticos más seguros; las reacciones adversas graves son muy raras. Pueden producir reacciones gastrointestinales, hepatotoxicidad y ototoxicidad. Además, las reacciones psiquiátricas se encuentran entre los efectos adversos esporádicamente asociados con su administración, aunque su mecanismo no está bien establecido. Casos descritos en la Food and Drug Administration (FDA) de EE.UU. muestran que la claritromicina y el ciprofloxacino son los antibióticos más frecuentemente asociados con el desarrollo de manía. Este término ha sido denominado antibiomanía. Presentamos tres casos clínicos vistos en una consulta de Atención Primaria en el período de un año con cuadros similares de hiperactividad y agresividad, coincidiendo con la administración de antibióticos de la familia de los macrólidos (AU)

Macrolides represent the 10-15% of the world-wide market of oral antibiotics. They are one of the safer groups of antibiotics, being the severe adverse reactions very rare. They can produce gastrointestinal reactions, hepatotoxicity and ototoxicity. The psychiatric reactions are found sporadically among the adverse effects. Cases reported to the FDA showed that clarithromycin and ciprofloxacin are the most frequent antibiotics associated with the development of mania. The syndrome has been termed antibiomania. We present three clinical cases seen in a Primary Care office in the last year with similar pictures of hyperactivity and aggressiveness coinciding with the administration of antibiotics of the family of the macrolides (AU)

¿Qué profesional médico es el más adecuado para impartir cuidados en salud a niños en Atención Primaria en países desarrollados? Revisión sistemática / What medical professional is the most adequate to provide health care to children in primary care in developed countries? Systematic review

Introducción: existe controversia sobre el tipo de profesional más adecuado –pediatras (PED) o médicos de familia/generales (MF/MG)– para prestar atención sanitaria a niños y adolescentes en Atención Primaria (AP). No existen revisiones sistemáticas previas que hayan estudiado este aspecto. El objetivo de este estudio es comparar la atención sanitaria proporcionada por PED y MF/MG en los siguientes aspectos de la práctica clínica: la prescripción de antibióticos (ATB), la indicación de pruebas diagnósticas, el manejo de la otitis media (OMA), del asma, del síndrome febril y de diversas alteraciones psicopatológicas, así como la realización de actividades preventivas. Material y métodos: diseño de estudio: revisión sistemática. Fuente de los datos: hasta diciembre de 2008 se revisaron las bases de datos MEDLINE y CENTRAL, el metabuscador TRIP Database y el buscador Google Académico para recuperar artículos originales y revisiones sistemáticas que compararan la práctica clínica de ambos tipos de profesionales. No se efectuó restricción por idioma. Selección de estudios: se incluyeron estudios de cualquier tipo de diseño (transversal, cohortes, casos y controles, experimentales) que compararan la práctica clínica del PED y el MF/MG. Se excluyeron todas las referencias que no contuvieran investigación original (cartas al director o editoriales). Asimismo, se evaluó la calidad metodológica de cada estudio con el instrumento “OSTEBA; Fichas de lectura crítica”. Dicha calidad era valorada de forma independiente por dos revisores, que llegaban a un consenso en caso de discrepancia. La extracción de datos fue realizada por siete parejas de revisores de forma independiente. Las discrepancias se resolvieron mediante consenso. Resultados: como promedio, los MF/MG prescribieron más ATB que los PED en infecciones del tracto respiratorio superior de probable etiología vírica –odds ratio (OR): 1,4; intervalo de confianza del 95% (IC 95%): 1,1-1,8–. Los PED tuvieron más probabilidades de adherirse a las recomendaciones de guías de práctica clínica sobre el manejo del síndrome febril (OR: 9; IC 95%: 3-25) y del trastorno por déficit de atención con/sin hiperactividad (OR: 5; IC 95%: 3-11), y una mayor capacidad de resolución para otras enfermedades de elevada prevalencia durante la infancia y la adolescencia (como asma y OMA). Los PED presentaban porcentajes de vacunación superiores a los de los MF/MG en todos los estudios que evaluaron este resultado. Conclusión: en vista de los resultados expuestos, parece recomendable mantener la figura del PED en los equipos de AP y reforzar su función específica como primer punto de contacto del niño con el sistema sanitario (AU)

Introduction: There is controversy about which health professional is the most adequate –pediatricians (PED) or family practitioners/general physicians (FP/GP)– to provide health care services to children and adolescents in Primary Care (PC). There are not previous systematic reviews approaching this subject in the previously published literature. The objective of this study is to compare health care provided between PED and FP/GP in the following aspects of the clinical practice: antibiotic (ATB) prescription; diagnostic test indication; acute otitis media (AOM), asthma, febrile syndrome and several psychopathological conditions’ management; and preventive measures accomplishment. Material and methods: study design: systematic review. Data sources: MEDLINE and CENTRAL databases, TRIP Database and Google Scholar, were searched until December 2008 to retrieve original papers and systematic reviews comparing the clinical practice of both kinds of health professionals. No language restriction was made. Studies’ selection: studies of any kind of design were included (cross-sectional, cohorts, case-controls and experimental) comparing the clinical practice of PED and FP/GP. The references without original research were excluded (letters to the editor, editorials). The methodological quality of each study was assessed with the tool “OSTEBA; Critical Appraisal Cards”. Two reviewers assessed the quality of the studies independently, achieving consensus in case of discrepancy. Seven pairs of reviewers made the data extraction independently. Discrepancies were achieved by consensus. Results: On average, FP/GP prescribed more ATB than PED in upper respiratory tract infections of probable viral etiology –odds ratio (OR): 1.4; 95% confidence interval (95% CI): 1.1-1.8–; PED were more likely to adhere to clinical guidelines recommendations on febrile syndrome management (OR: 9; 95% CI: 3-25) and on attention deficit disorder with/without hyperactivity (OR: 5; 95% CI: 3-11), and showed more resolution capacity on other highly prevalent conditions in children and adolescents (such as asthma and AOM). PED showed higher vaccination coverage than FP/GP in all the studies assessing this result. Conclusion: based on the presented results, it seems reasonable to recommend maintaining the PED figure in PC health centers and reinforcing its specific task as the first point of contact of the child with the health care system (AU)

El uso de propionato de fluticasona inhalado no parece modificar la historia natural del asma en niños menores de cinco años con sibilancias / Inhaled flucticasone doesn´t seem to modify natural history of asthma in wheezy children under five

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[Passive smoking and other risk factors associated to the lower respiratory illnesses in sucking infants]. / Tabaquismo pasivo y otros factores de riesgo en las afecciones respiratorias de vías bajas en los lactantes.

OBJECTIVES: We try to evaluate the frequency of lower respiratory illnesses (LRIs), during the first year of life and it's relation to other risk factors, overall passive smoking and modes of feeding. DESIGN: This is a retrospective study in our city. SETTING: Primary Health Care. PATIENTS AND OTHER PARTICIPANTS: The study population is 240 children during the first year of life, born in 1993 and we have collected clinical information about risk factors and LRIs number. MEASUREMENTS AND MAIN RESULTS: A 37% have suffered from at least one episode of LRIs, during the first year of life. The parental smoking appears in 46.6%. The incidence of LRIs was strongly associated with passive smoking (OR = 1.86), exclusive breast-feeding and at least for 5 months (OR = 2.1) and older brothers (OR = 3.12). The number of episodes of LRIs was statistically significative higher in males (males 0.82 +/- 1.67 episodes; females 0.48 +/- 0.67 episodes) (p = 0.0489). CONCLUSIONS: In our report, the risk factors more strongly related with LRIs in suckling infants are passive smoking, older brothers, male sex and less than 5 months of breast feeding.

[An experimental study on the effects of maternal hyperphenylalaninemia on the central nervous system and behavior of offspring rats]. / Estudio experimental sobre los efectos de la hiperfenilalaninemia materna en el sistema nervioso central y la conducta de ratas hijas.

OBJECTIVE: This work attempts to study the cerebral alterations in rat offspring of hyperphenylalaninemic mothers, as well as the possibility of preventing them by means of administration of dietetic supplements of valine, leucine and isoleucine during the pregnancy. PATIENTS AND METHODS: An experimental study in two consecutive pregnancies of 18 Wistar rats was carried out. The first pregnancy serves as the control group. In the second pregnancy, an experimental hyperphenylalaninemia was provoked by means of injection of phenylalanine and chlorophenylalanine (phenylalanine-hydroxylase inhibitor). In half of the mothers during the second pregnancy the diet was supplemented with branched-chain amino acids. In the offspring rats, a histological cerebral study was performed (conventional electron microscopy and study of synaptosomes). A behavioral study (T-water maze) was also performed at birth and on the 35th and 65th days of life. RESULTS: The offspring of the group submitted to hyperphenylalaninemia were microcephalic (p = 0.0003) and had fewer synaptosomes that had a larger surface area (p = 0.0081 in newborn rats, p = 0.0028 on the 35th day of life) and of a more immature aspect (less vesicular content). In addition, alteration in the myelinization were detected. In the behavior test (65th day of life), the offspring of the mothers with hyperphenylalaninemia make significantly more mistakes (p = 0.0167) and they needed more time for their resolution (p = 0.059). None of these alterations could be prevented by the administration of supplements of branched-chain amino acids to the mother. These supplements resulted in a higher fertility rate, but this action results in affected young rats, so their administration seems to be counter-productive.

[Acute otitis media in the first year of life and its relationship with various risk factors]. / Otitis media aguda durante el primer año de vida y su relación con algunos factores de riesgo.

OBJECTIVE: The purpose of the present study was to evaluate the frequency of acute otitis media (OMA) in our city (urban population) during the first year of life and its relationship to some risk factors. PATIENTS AND METHODS: This is a retrospective study of 240 children. We collected information about risk factors (sex, gestational age, birthweight, duration of breastfeeding, older siblings, parental smoking and nursery care). We related these to the number of OMA episodes during the first year of life. RESULTS: Of the infants studied 40% had suffered at least one episode of OMA during the first year of life. There was a higher incidence during winter and spring. Three out of every four episodes occurred after six months of age. The incidence of OMA was strongly associated to whether there were older siblings (odds ratio: 1.98) and to the male sex (odds ratio: 1.98). Children in the breastfed group (exclusive breastfeeding for at least 5 months) have less otitis episodes than the milk-adapted formula group, but the difference was not statistically different (0.41 +/- 0.68 vs 0.69 +/- 1.01 episodes; p = 0.11). CONCLUSIONS: In our report, the only risk factor strongly related with OMA in suckling infants are the presence of older siblings and the male sex. Breastfeeding did not have a protective effect in comparison to commercial formula, although a prospective study might be of interest for further addressing this issue.

[Is general screening for anemia and iron deficiency justified in nursing infants?]. / Está justificado el cribado generalizado de anemia y ferropenia en los lactantes?

OBJECTIVE: To establish the necessity of anemia and iron deficiency screening in breast-feeders in our environment. DESIGN: A crossover study, after data collection from case records. SETTING AND PATIENTS: 93 children of 18 and 24 months living in a urban area. All of them are included in the Healthy Breast-feeder Programme of the Health Center of Teruel city. INTERVENTIONS: Detection in venous blood of hematocrit, hemoglobin, mean corpuscular volume, mean corpuscular hemoglobin, transferrin saturation and ferritin in serum. MEASUREMENTS AND MAIN RESULTS: We founded a 1.1% of anemia with iron deficiency and a 3.4% of latent iron deficiency. We detected a total of 5.4% cases of iron deficiency. We didn't find any statistical significance when comparing the haematic values among children who had received different kinds of milk nor in relation with the time in which they got it. We didn't find either any differences when comparing such values among those who had received iron prophylaxis and those in which this treatment was not considered necessary. CONCLUSIONS: Therefore we suggest selective iron prophylaxis for risk groups and laboratory studies only in those with evident signs of anemia or iron deficiency.