Aparición temprana de varicela modificada en niños vacunados con una dosis / Early presentation of breakthrough varicella in vaccinated children

Introducción: El uso sistemático de la vacuna de la varicela en niños ha conseguido una reducción significativa de la morbimortalidad. Sin embargo, persiste la incidencia de varicela en sujetos vacunados, varicela modificada (VM), lo que ha motivado la incorporación de una segunda dosis a los calendarios vacunales, a una edad que podría ser demasiado tardía. Se pretende medir el tiempo trascurrido desde la vacunación hasta la aparición de la VM. Pacientes y métodos: Se presentan 23 casos de niños diagnosticados de VM (media de edad al diagnóstico: 4,85 años), vacunados con una dosis (media de edad de vacunación: 2,37 años). Resultados: El tiempo medio transcurrido desde la vacunación hasta la VM fue de 2,48 años y la mediana 2,0 años. El 13% de los niños diagnosticados de VM habían sido vacunados el año previo y el 52%, en los 2 previos, tiempo inferior al recomendado para recibir la segunda dosis de vacuna según los calendarios vigentes. Conclusiones: Para disminuir los fallos vacunales, podría considerarse la aproximación de las dosis de vacuna e incluso la administración consecutiva (AU)

Introduction: The introduction of a routine varicella vaccination program for children has achieved a significant reduction in morbidity and mortality due to varicella. However, there is still an incidence of chickenpox in those vaccinated, called “varicella breakthrough” (VB). This has led to the inclusion of a 2nd dose vaccination schedule, at an age which could be too late. Patients and methods: This study presents 23 cases of children diagnosed with VB (mean age at diagnosis 4.85 years) who had been vaccinated with one dose of varicella vaccine (mean age of vaccination 2.37 years). Results: The mean time between the vaccine and the disease was 2.48 years, with a median of 2.0 years. VB was diagnosed in 13% of children who had been vaccinated the previous year, and 52% diagnosed in the previous two. Therefore many of these patients had suffered the disease before the recommended time of administration of the second dose of vaccine according to the current vaccine schedules. Conclusions: To avoid these vaccine failures, it would be appropriate to bring the two doses of varicella vaccine closer, or even assess the pattern of two consecutive doses (AU)

[Early presentation of breakthrough varicella in vaccinated children]. / Aparición temprana de varicela modificada en niños vacunados con una dosis.

INTRODUCTION: The introduction of a routine varicella vaccination program for children has achieved a significant reduction in morbidity and mortality due to varicella. However, there is still an incidence of chickenpox in those vaccinated, called "varicella breakthrough" (VB). This has led to the inclusion of a 2nd dose vaccination schedule, at an age which could be too late. PATIENTS AND METHODS: This study presents 23 cases of children diagnosed with VB (mean age at diagnosis 4.85 years) who had been vaccinated with one dose of varicella vaccine (mean age of vaccination 2.37 years). RESULTS: The mean time between the vaccine and the disease was 2.48 years, with a median of 2.0 years. VB was diagnosed in 13% of children who had been vaccinated the previous year, and 52% diagnosed in the previous two. Therefore many of these patients had suffered the disease before the recommended time of administration of the second dose of vaccine according to the current vaccine schedules. CONCLUSIONS: To avoid these vaccine failures, it would be appropriate to bring the two doses of varicella vaccine closer, or even assess the pattern of two consecutive doses.

Tratamiento exitoso con penicilina benzatina de dos pacientes con sospecha de PANDAS / Successful treatment with benzathine penicillin of two patients suspected of suffering from PANDAS

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Prevalence of insulin resistance and impaired glucose tolerance in a sample of obese Spanish children and adolescents.

The prevalence of obesity in children has increased in developed countries in the last decades. It is associated with alterations in glucose metabolism that may be present in childhood. To assess the frequency of glucose metabolism alterations and insulin resistance and their possible determinants in a sample of obese children from Valladolid (Spain), we retrospectively studied 100 obese children and adolescents (11.59 ± 2.73 years). Anthropometric measures, biochemical parameters, and oral glucose tolerance test (OGTT) were performed. Insulin resistance was evaluated with fasting insulin, HOMA index, and insulin values in OGTT. Impaired glucose tolerance was found in 15% of the sample, and was the most frequent of glucose metabolism alterations. Impaired fasting glucose was found in 2%. No case of type 2 diabetes was found. Acanthosis nigricans was present in 22%, with predominance in females, but not all presented insulin resistance. The prevalence of insulin resistance was 29% when HOMA index was used, and 50% when the insulin response in OGTT was used. Not all patients with impaired glucose tolerance had a pathological HOMA index, and not all with pathological HOMA index presented insulin resistance when insulin values in OGTT were used. Higher 2-h post-OGTT insulin levels were found in children with impaired glucose tolerance. It is paramount to identify young people with glucose regulation alterations for early, intensive intervention to prevent or at least postpone the onset of type 2 diabetes. OGTT is a screening tool necessary to fulfill this objective.

Pubarquia prematura y masa suprarrenal / Premature pubarche associated with adrenal mass

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