Factores de riesgo de la precocidad sexual en adolescentes / Risk factors of sexual precocity in adolescents

Introducción: en los últimos años parece que la precocidad sexual de nuestros jóvenes ha ido en aumento. En este estudio queremos averiguar cuáles son los factores de riesgo adolescente que se relacionan de forma estadísticamente significativa con tener relaciones sexuales completas. Material y métodos: encuesta a 1289 adolescentes de segundo y tercero de Educación Secundaria Obligatoria de Castilla y León (España) en el curso 2010-2011. Analizamos múltiples variables epidemiológicas, calculando medidas de centralización y dispersión en las variables cuantitativas, y de distribución de frecuencias en las cualitativas. Resultados: hemos estudiado a 563 varones y 726 mujeres. La edad media de los encuestados fue de 14,05 años (mediana y moda: 14 años; rango: 12-17 años), sin existir diferencias entre sexos. El 17,5% había tenido relaciones sexuales con penetración (el 9% a los 12; el 6% a los 13; el 10,6% a los 14; el 34,2% a los 15; el 53,2% a los 16 y el 57,1% a los 17 años). Este porcentaje era mayor en los chicos (20,2%) que en las chicas (15,4%). Otros factores asociados de forma estadísticamente significativa (p<0,05) con haber tenido relaciones sexuales coitales fueron mayor edad, peor relación con sus padres, padres divorciados, peor relación entre sus padres, fumar, beber alcohol, emborracharse, consumir drogas, peor salud actual, peor alimentación, peor memoria, ser más erotofílicos y definirse como agnóstico o ateo. Conclusiones: además de con el alcohol, el tabaco y otras drogas también es factor de riesgo de precocidad sexual adolescente tener una mala relación con los padres y de los padres entre sí (AU)

Introduction: in the last years, sexual initiation in our young people seems to have anticipated. In this study we want to find out what risk factors have statistically significant relation to having sexual relations with penetration in adolescents. Methods: 1289 students of 2.º and 3.º grade of Secondary Education in the region of Castilla-León (Spain) were interrogated in the 2010-2011 school year. Multiple epidemiological variables were analyzed, calculating centralization and dispersion in quantitative variables, and distribution of frequencies in qualitative variables. Results: 563 boys and 726 girls were studied. The students’ media age was 14.05 years (median and mode: 14 years; range: 12-17 years). 17.5% had had sexual relations with penetration. (9% at 12; 6% at 13; 10.6% at 14; 34.2% at 15; 53.2% at 16 and 57.1% at 17 years). This percentage was greater in boys (20.2%) than girls (15.4%). Other statistically significant associated factors (p< 0.05) were being older, worse relation with his parents, divorced parents, worse relation between their parents, smoking, drinking alcohol, getting drunk, consuming drugs, worse present health, worse feeding, worse memory, having more erotophilia and being agnostic or atheist. Conclusions: adolescent sexual precocious initiation risk factors are alcohol, tobacco, drug consumption, a bad relationship with their parents and between their parents (AU)

Adecuación de los hábitos de introducción del gluten a las recomendaciones actuales / The suitability of the current recommendations for introducing gluten to the diet

Introducción: Hemos evaluado los hábitos de introducción de gluten y el cumplimiento de las recomendaciones de ESPGHAN-2008 en nuestro medio. Material y métodos: Estudio de cohortes retrospectivo en 2011 mediante encuesta rellenada por padres de niños que acuden al pediatra entre 12-18 meses, que contenía diversas variables epidemiológicas y de alimentación complementaria. Para las variables cuantitativas se calcularon medidas de centralización y tendencia, y tests no paramétricos para comparación de medias (Mann-Whitney y Kruskal-Wallis), y para las variables cualitativas, análisis de frecuencias, y comparación mediante χ2 o pruebas exactas. Se utilizaron técnicas de ajuste multivariante para las variables significativas. Resultados: Han colaborado 46 pediatras de atención primaria que recogieron 1.015 encuestas. La edad media de introducción de gluten fue 6,99 meses (desviación estándar 1,46, mediana 7). Solo el 45,1% (intervalo de confianza del 95% [IC 95%]: 41,8-48,3%) lo introdujo entre 4-6 meses, 0,2% antes de los 4, y 54,7% tras cumplir 7 meses. Solamente el 13,9% (IC 95%: 11,6-16,1%) lo hace entre 4-6 meses con lactancia materna. El análisis multivariante demuestra que las variables ligadas a un menor cumplimiento de la introducción entre 4-6 meses son madres de 35 años o mayores (OR ajustada [ORa] 1,44; IC 95%: 1,11-1,88), familiar celíaco (ORa 2,04; IC 95%: 1,11-3,72) y lactancia materna (ORa 1,55; IC 95%: 1,06-2,26), y para la introducción entre los 4-6 meses coincidiendo con lactancia al pecho, la lactancia materna y estudios universitarios maternos (OR 1,72; IC 95%: 1,17-2,53). Conclusiones: Aún no está suficientemente implantada la recomendación de la ESPGHAN sobre introducción de gluten entre los pediatras de nuestro entorno (AU)

Introduction: The habits of introducing gluten and the implementation of the ESPGHAN-2008 recommendations are evaluated. Materials and methods: A retrospective cohort study was conducted in 2011 using a questionnaire containing various epidemiological variables and supplementary feeding that was completed by the parents of children between 12-18 months who were seen by the pediatrician. Central tendency measures were calculated for the quantitative variables, and non-parametric tests used for comparison of means (Mann-Whitney and Kruskal-Wallis). The Chi-squared or exact tests were used for analyzing the qualitative variables, analysis of frequencies and comparisons. Multivariate adjustment techniques were used for the significant variables. Results: A total of 46 primary care pediatricians, who collected 1,015 questionnaires, collaborated. The mean age of the introduction of gluten was 6.99 months (standard deviation 1.46, median 7). Only 45.1% (95% confidence interval [CI 95%]: 41.8-48.3) introduced it between 4-6 months, 0.2% before 4 months, and 54.7% after 7 months. Only 13.9% (CI 95% 11.6-16.1) introduced gluten between 4-6 months with breastfeeding. Multivariate analysis showed that the variables linked to lower compliance with the introduction between 4-6 months are mothers of 35 years of age or older (adjusted Odds ratio (aOR 1.44; CI95%: 1.11-1.88), celiac family (aOR 2.04; CI 95%: 1.11-3.72) and breastfeeding (aOR 1.55; CI 95%: 1.06-2.26), and for the introduction between 4-6 months coinciding with breastfeeding, breastfeeding and mothers who had studied at university (aOR 1.72; CI 95%: 1.17-2.53). Conclusions: The ESPGHAN recommendation on the introduction of gluten among pediatricians in our sector has not yet been sufficiently implemented (AU)

[The suitability of the current recommendations for introducing gluten to the diet]. / Adecuación de los hábitos de introducción del gluten a las recomendaciones actuales.

INTRODUCTION: The habits of introducing gluten and the implementation of the ESPGHAN-2008 recommendations are evaluated. MATERIALS AND METHODS: A retrospective cohort study was conducted in 2011 using a questionnaire containing various epidemiological variables and supplementary feeding that was completed by the parents of children between 12-18 months who were seen by the pediatrician. Central tendency measures were calculated for the quantitative variables, and non-parametric tests used for comparison of means (Mann-Whitney and Kruskal-Wallis). The Chi-squared or exact tests were used for analyzing the qualitative variables, analysis of frequencies and comparisons. Multivariate adjustment techniques were used for the significant variables. RESULTS: A total of 46 primary care pediatricians, who collected 1,015 questionnaires, collaborated. The mean age of the introduction of gluten was 6.99 months (standard deviation 1.46, median 7). Only 45.1% (95% confidence interval [CI 95%]: 41.8-48.3) introduced it between 4-6 months, 0.2% before 4 months, and 54.7% after 7 months. Only 13.9% (CI 95% 11.6-16.1) introduced gluten between 4-6 months with breastfeeding. Multivariate analysis showed that the variables linked to lower compliance with the introduction between 4-6 months are mothers of 35 years of age or older (adjusted Odds ratio (aOR 1.44; CI95%: 1.11-1.88), celiac family (aOR 2.04; CI 95%: 1.11-3.72) and breastfeeding (aOR 1.55; CI 95%: 1.06-2.26), and for the introduction between 4-6 months coinciding with breastfeeding, breastfeeding and mothers who had studied at university (aOR 1.72; CI 95%: 1.17-2.53). CONCLUSIONS: The ESPGHAN recommendation on the introduction of gluten among pediatricians in our sector has not yet been sufficiently implemented.

Increased resting energy expenditure by fat-free mass in children and teenagers with constitutional leanness.

BACKGROUND/OBJECTIVES: To compare the resting energy expenditure (REE) and the REE/Fat-free-mass (FFM) quotient in children with constitutional leanness (CL) and children with normal body weight, and to describe the within-family clustering of CL. SUBJECTS/METHODS: We have studied 18 children and teenagers with CL, 10 girls and 8 boys, and 18 gender and age matched normal controls, with the same pubertal stage. All were recruited from the outpatient pediatric clinic nutrition unit. None of the children with CL showed symptoms of chronic illness, they had normal laboratory results, they had a normal caloric food intake, and they did not agree with the DSM-IV-TR criteria for anorexia nervosa. We describe the body mass index (BMI) of children and their parents. The children were classified according to Cole's recently published BMI cut-offs for thinness: under 18.5 points in CL group, stable at least in the last year, and between 18.5 and 25 cutt-offs in the control group. The body composition was calculated by anthropometric methods (skinfold thickness measurements). In addition REE was measured using fasting indirect calorimetry. RESULTS: The CL group had a higher mean percentage of FFM, and a mean FM significantly less, relative to controls (p < 0.001). The average absolute REE was significantly lower in the CL group (1,106.55 ± 240.72 kcal) than the control group (1,353.33 ± 270.01 kcal/dia) (p < 0.01). However, the REE adjusted for FFM showed a mean significantly greater in the CL group (41.39 ± 2.26 kcal/kg FFM) (Mean confidence interval (CI) 95 %: 40.33-42.45) than the controls (37.37 ± 3.06 kcal/kg FFM) (Mean CI 95 %: 35.93-38.81) (p < 0.001). Finally, in the family study, the mean BMI of fathers of CL group was significantly lower (p < 0.01), but there were not any differences in the mean BMI of mothers. Among parents with BMI known, 8 of 35 parents of CL group had an BMI lower 18.5, and only 2 of 36 parents in the control group (p < 0.05). CONCLUSIONS: This increased energy expenditure-to-FFM ratio differentiates between CL and controls. These metabolic differences are probably genetically determined.

Diagnóstico clínico y cribado de la enfermedad celíaca / No disponible

La enfermedad celíaca, que es el trastorno digestivo crónico más prevalente, tiene un origen autoinmune y asienta en sujetos genéticamente predispuestos. Al margen de la sospecha clínica ante la presencia de síntomas digestivos o extradigestivos conocidos, hoy se impone un diagnóstico de despistaje en muchas situaciones para las que existe evidencia de asociación con la misma, como la diabetes tipo 1, síndromes de Down, Turner y Williams, déficit selectivo de IgA, tiroiditis autoinmune y familiares en primer grado de pacientes celiacos. No existe suficiente evidencia para recomendar un cribado poblacional en masa fuera de los grupos de riesgo expuestos. La técnica de elección para la misma es la determinación de IgA anti-transglutaminasa tisular. De otro lado, la determinación de antígenos HLA DQ2/DQ8 puede ser útil en casos dudosos o serología negativa en grupos de riesgo, ya que su valor predictivo negativo es cercano al 100%

Celiac disease is the most prevalent chronic digestive disorder, it has an autoimmune origin and it appears in genetically predisposed persons. Apart from the clinical suspicion, there are many situations with evidence of association with celiac disease (type 1 Diabetes mellitus, Down, Turner and Williams syndromes, IgA selective deficit, autoimmune thyroiditis and first degree relatives of celiac patients) that make compulsory a screening diagnosis. There’s not enough evidence to recommend a mass poblational screening. The serologic marker of choice is human tissue transglutaminase IgA. On the other hand, the HLA DQ2/DQ8 antigens determination could be useful in uncertain cases or negative serology results in risk groups, since its negative predictive value is almost 100 percent

[Epidemiology of type 1 diabetes in children and adolescents aged less than 15 years in the provinces of Castilla y León]. / Epidemiología de la diabetes tipo 1 en menores de 15 años en las provincias de Castilla y León.

INTRODUCTION: The incidence of type 1 diabetes shows wide geographical variability and heterogeneity. The aim of this study was to determine the incidence and prevalence of type 1 diabetes in children and adolescents ages less than 15 years in the different provinces of Castilla-León. MATERIAL AND METHODS: To determine incidence, all new cases of type 1 diabetes with onset under 15 years of age in 2003-2004 were obtained. Incidence was expressed as the crude value with the corresponding confidence interval and as standardized incidence. The capture-recapture method was used to calculate the completeness of ascertainment. To determine prevalence, all cases of type 1 diabetes in persons ages less than 15 years at 31 December 2004 were obtained. RESULTS: Incidence showed wide variability among the different provinces of Castilla-León. The highest values were found in Segovia (38.77/100,000/year), Valladolid (32.07/100,000/ year) and Avila (23.21/100,000/year) and the lowest in Zamora (8.14/100,000/year). Incidences were highest in the 5-9 years age group in all provinces except Burgos. Prevalence was highest in Segovia (1.54/1,000), Valladolid (1.41/1,000), Avila (1.38/1,000) and Zamora (1.32/1,000) and lowest in Burgos (0.91/1,000). CONCLUSIONS: Castilla-León seems to have one of the highest incidences of type 1 diabetes in Spain; several of its provinces have values similar to those in Northern Europe.

Epidemiología de la diabetes tipo 1 en menores de 15 años en las provincias de Castilla y León / Epidemiology of type 1 diabetes in children and adolescents aged less than 15 years in the provinces of Castilla y León (Spain)

Introducción La incidencia de diabetes tipo 1 presenta gran heterogeneidad y variabilidad geográfica. El objetivo de este estudio es determinar la incidencia y prevalencia de la diabetes tipo 1 en niños menores de 15 años en las distintas provincias de Castilla y León. Material y métodos Para el estudio de la incidencia se recogieron los nuevos diagnósticos de diabetes tipo 1 en menores de 15 años en 2003-2004. La incidencia se expresó como valor crudo con su intervalo de confianza y como incidencia estandarizada. Se utilizó el método captura-recaptura para calcular la exhaustividad. Para el cálculo de la prevalencia se recogieron todos los diabéticos tipo 1 menores de 15 años existentes en Castilla y León a fecha 31 de diciembre de 2004. Resultados Las cifras de incidencia son muy heterogéneas en las diferentes provincias de Castilla y León: las más altas se observaron en Segovia (38,77/100.000/año), Valladolid (32,07/100.000/año) y Ávila (23,21/100.000/año) y las menores en Zamora (8,14/100.000/año). El grupo de edad con mayor incidencia fue el de 5-9 años en todas las provincias excepto en Burgos. La mayor prevalencia se observa en Segovia (1,54/1.000), Valladolid (1,41/1.000), Ávila (1,38/1.000) y Zamora (1,32/1.000) y la menor en Burgos (0,91/1.000). Conclusiones Castilla y León parece tener una de las mayores incidencias de diabetes tipo 1 en España, con cifras en varias de sus provincias similares a las de algunos países nórdicos

Introduction The incidence of type 1 diabetes shows wide geographical variability and heterogeneity. The aim of this study was to determine the incidence and prevalence of type 1 diabetes in children and adolescents ages less than 15 years in the different provinces of Castilla-León. Material and methods To determine incidence, all new cases of type 1 diabetes with onset under 15 years of age in 2003-2004 were obtained. Incidence was expressed as the crude value with the corresponding confidence interval and as standardized incidence. The capture-recapture method was used to calculate the completeness of ascertainment. To determine prevalence, all cases of type 1 diabetes in persons ages less than 15 years at 31 December 2004 were obtained. Results Incidence showed wide variability among the different provinces of Castilla-León. The highest values were found in Segovia (38.77/100,000/year), Valladolid (32.07/100,000/ year) and Ávila (23.21/100,000/year) and the lowest in Zamora (8.14/100,000/year). Incidences were highest in the 5-9 years age group in all provinces except Burgos. Prevalence was highest in Segovia (1.54/1,000), Valladolid (1.41/1,000), Ávila (1.38/1,000) and Zamora (1.32/1,000) and lowest in Burgos (0.91/1,000). Conclusions Castilla-León seems to have one of the highest incidences of type 1 diabetes in Spain; several of its provinces have values similar to those in Northern Europe

[Home enteral nutrition in Spain. Results of the register of the Spanish Society of Pediatric Gastroenterology, Hepatology and Nutrition in 2003]. / Nutrición enteral domiciliaria en España. Resultados del registro de la Sociedad Española de Gastroenterología, Hepatología y Nutrición Pediátrica del año 2003.

INTRODUCTION: The number of children receiving prolonged home enteral nutrition (HEN) is increasing. However, precise information on the incidence and prevalence of HEN in Spain is lacking. Consequently, the Spanish Society of Pediatric Gastroenterology, Hepatology and Nutrition created a patients' register (NEPAD). The aim of the present study was to analyze the results of the first year of the NEPAD register (2003). MATERIAL AND METHODS: The NEPAD is an on-line register that gathers information on the indications for HEN, route of access, type of diet and duration of nutritional support. Quantitative data are expressed as mean and standard deviation, and qualitative data as percentages. RESULTS: In 2003, 124 children from 6 hospitals were registered. The mean age at the beginning of HEN was 3.6 years. The underlying disease was gastrointestinal in 20%, neurological or mental retardation in 20%, cystic fibrosis in 14.5%, tumor in 11%, innate error of metabolism in 10%, congenital cardiac disease in 6%, severe primary malnutrition in 6%, and other causes in 13%. A nasogastric tube was used as the first route of access in 56%, and gastrostomy was used in 42%. Sixty percent of the children received continuous nocturnal enteral nutrition and 90% used an infusion pump. The type of feeding consisted of blenderized natural food in 14%, polymeric pediatric formula in 50%, and infant formulae in 18%. On December 31st, 84 children continued to receive enteral nutrition (68%). CONCLUSIONS: Despite the efforts made to maintain the on-line national register, it has been underused in its first year of existence (2003). Patients with gastrointestinal or neurological diseases constitute the main group of patients in the register. There is a slight preference for the use of nasogastric tube over gastrostomy.

Colestasis aguda y quiste de colédoco tipo IVa. A propósito de un caso / Acute cholestasis and type IVa choledoch cyst. A case report

El quiste de colédoco se encuadra dentro del grupo de las dilataciones quísticas de la vía biliar, conjunto infrecuente de malformaciones congénitas que afecta tanto a la vía biliar intrahepática como a la extrahepática. Es más frecuente en países asiáticos y en niñas. El objetivo de nuestro trabajo es la presentación de nuestra reciente experiencia con un caso de quiste de colédoco en una niña de 23 meses, que acude a nuestro Servicio por presentar cuadro de astenia, anorexia y dolor abdominal intermitente de 2 semanas de evolución, que se acompaña posteriormente de ictericia, coluria y acolia. Asociaba alteración analítica importante de la función hepática y en la ecografía abdominal se observó dilatación importante de la vías biliares intrahepática y extrahepática, que se confirma con la realización de colangio-resonancia magnética (colangio-RM), demostrándose la presencia de quiste de colédoco tipo IVa según clasificación de Todani. Se practica extirpación total del quiste y hepaticoyeyunostomía en Y de Roux. Se realiza a continuación una revisión de la bibliografía existente sobre esta patología

The choledochal cyst is classified inside cystic dilations of the biliary tract, infrequent group of congenital malformations that affects as much an intrahepatic as a extrahepatic biliary tract. It’s more commonly in Asian countries and in little girls. Our study purpose is to present a recent experience with a choledochal cyst case in a little girl of 23 months, who visits our service for symptoms of asthenia, anorexia and intermittent abdominal pain for two weeks, accompanied afterwards of jaundice, coluric urine and acholia. She’s linked an important analytic alteration of hepatic function and in the abdominal ultrasonography we could see an important dilation of intrahepatic and extrahepatic biliary tract, that it’s confirmed with the magnetic resonance cholangiography (MRC), what proved the presence of the choledochal cyst type IVa, according Todani’s classification. We perform the total extirpation of the cyst and Roux-en-Y hepaticojejunostomy. We below make an existing bibliography revision connected with this pathology

Rotavirus G9 es la principal causa de diarrea aguda en niños ingresados menores de 5 años / Rotavirus G9 is the principal cause of acute diarrhea in hospitalized children under five years of age

Objetivos: analizar el perfil etiológico de la diarrea aguda en niños ingresados menores de 5 años, y la distribución de los serotipos de rotavirus en nuestro medio. Métodos: estudio prospectivo observacional descriptivo llevado a cabo en todos los niños de 1 mes a 5 años de edad, ingresados por diarrea aguda en el Servicio de Pediatría del Hospital de León, entre 15 de enero y 31 de diciembre de 2005. En todos los casos se realizó coprocultivo para bacterias enteropatógenas, y estudio de virus en heces por inmunocromatografía para rotavirus y adenovirus, y enzimoinmunoensayo para astrovirus, y posteriormente por reacción en cadena de la polimerasa a tiempo real (RT-PCR) para rotavirus, analizando con esta última los genotipos G del mismo. Idéntico estudio se llevó a cabo en los casos de diarrea nosocomial. Resultados: en el período estudiado hubo un total de 1.037 ingresos (excluída la edad neonatal), de los cuales 674 (65%) fueron menores de 5 años. Se incluyeron en el estudio 106 niños: 90 ingresados por diarrea aguda comunitaria (13,3 % de los ingresos en ese grupo de edad), y 16 casos de diarrea nosocomial. En el primer grupo se aisló un patógeno bacteriano en un 13,3% (Campylobacter y Salmonella a partes iguales), y en el 43,3% un virus (rotavirus 87,1%, astrovirus 17,9%, y adenovirus 5,1%), con algunos casos de coinfección. Rotavirus se aisló por tanto en un 37,7% de los ingresos por diarrea comunitaria. El único gérmen aislado en la diarrea nosocomial fue rotavirus, en un 37,5%. Se analizó el tipo G de 26 cepas de rotavirus: G9 57,7%, G1 15,4%, G2 11,5%, G3 11,5%, G4 0, y G9+G3 3,8%. Conclusiones: rotavirus es la causa más frecuente de diarrea aguda en niños hospitalizados menores de 5 años, siendo responsable de más de un tercio de los casos tanto en la diarrea comunitaria como en la nosocomial. Más de la mitad de los rotavirus aislados mostraban el tipo G9

Objectives: analyze the etiological profile of acute diarrhea in hospitalized children under five years of age and the distribution of the rotavirus serotypes in our setting. Methods: perspective, observational, descriptive study conducted in all the children from one month to five years of age hospitalized due to acute diarrhea in the Pediatrics Department of the Hospital de Leon, between January 15 and December 31, 2005. In all the cases, stool culture was made for enteropathogenic bacteria and the virus study was done in stools by immunochromatography for rotavirus and adrenovirus and enzyme immunoassay was done for astrovirus and subsequently by real time polymerase chain reaction (RT-PCR) for rotavirus, analyzing the G genotypes in the latter. An identical study was conducted in the cases of nosocomial diarrhea. Results: in the period studied, there were a total of 1037 hospital admissions (neonatal age being excluded). Atotal of 674 (65%) of them were under five years of age. One hundred six children were included in the study: 90 admitted for community acute diarrhea (13.3% of those admitted in this age group), and 16 cases of nosocomial diarrhea. In the first group, a bacterial pathogen was isolated in 13.3% (Campylobacter and Salmonella equally). In 43.3%, a virus (rotavirus 87.1%, astrovirus 17.9%, and adenovirus 5.1%) was isolated with some cases of coinfection. Thus, rotavirus was isolated in 37.7% of those admitted due to community diarrhea. The only germ isolated in nosocomial diarrhea was rotavirus in 37.5%. The type G of 26 rotavirus strains was analyzed: G9 57.7%, G1 15.4%, G2 11.5%, G3 11.5%, G4 0, and G9+G3 3.8%. Conclusions: rotavirus is the most frequent cause of acute diarrhea in hospitalized children under five years of age, it being responsible for more than one third of the cases of both community and nosocomial diarrhea. More than half of the rotaviruses isolated had type G9

Comparación de la utilidad de la fiebre y de algunos parámetros analíticos para el diagnóstico de pielonefritis aguda en niños / Comparison of the utility of fever and some laboratory parameters to diagnose acute pyelonephritis in children

Objetivo. Comparar la utilidad de un parámetro clínico como la fiebre, con parámetros analíticos en el diagnóstico temprano de pielonefritis aguda. Material y Métodos. Se estudiaron un total de 35 niños (10 varones) con el diagnóstico de infección urinaria, hospitalizados en el Servicio de Pediatría del hospital de León y a los que se les practicó una gammagrafía renal con DMSA como prueba de referencia para el diagnóstico de pielonefritis aguda. En el momento del ingreso se midió la temperatura axilar y se realizó extracción sanguínea para determinar velocidad de sedimentación globular, niveles séricos de proteína C-reactiva y de interleuquina-6. Se comparó la utilidad de la fiebre y de los parámetros analíticos para el diagnóstico de pielonefritis aguda calculando para cada uno de ellos sensibilidad, especificidad, valor predictivo positivo y negativo, coeficiente de probabilidad e índice de Youden. Resultados. Se demostró la existencia de pielonefritis aguda en 18 (51,5%) pacientes con edad media de 55,6 + 50,5 meses. El 100% presentaron fiebre al diagnóstico. En 17 (48,5%) pacientes, con edad media de 39,1+55,1 meses, la gammagrafía renal fue normal y 8 (47,06%) presentaban fiebre al diagnóstico. La sensibilidad para detectar la localización de las infecciones urinarias de la temperatura axilar > 38º, velocidad de sedimentación globular > 20, proteína –C-.reactiva > 5 mg/l e interleuquina-6>4 pg/ml fue de uno y la especificada de la proteína –C-reactiva > 70 mg/l y de la interleuquina -6>15 pg/ml fue próxima a uno. Conclusiones. El diagnóstico de pielonefritis aguada puede ser casi totalmente descartado en los niños con infección urinaria que no tienen fiebre. Los parámetros analíticos estudiados no tienen más sensibilidad que la fiebre para diagnosticar pielonefritis aguda y sólo tienen una alta especificidad cuando sus niveles séricos son muy elevados (AU)

Aim: To compare the use of a clinical parameter such as fever with analytical parameters for early diagnosis of acute pyelonephritis. Material and methods. The study was conducted in 35 children (10 male) diagnosed with urinary infection and hospitalized in the Paediatric Department in the Leon Hospital, who underwent DMSA renal scintigraphy to test for acute pyelonephritis. Auxiliary temperature was read on admission and a blood sample take to determine the rate of globular sedimentation, serum levels of C-reactive protein and interleukin-6. The usefulness of fever was compared with analytical parameters in diagnosing acute pyelonephritis and in each case sensitivity, specificity, positive and negative predictive values, probability co-efficient and the Youden index were calculated. Results. There was evidence of acute pyelonephritis in 18 (51,5%) patient, with an average age of 55.6+50.5 months. Of these 100% registered fever at diagnosis. Seventeen 17 (48,5%) patients with an average age of 39.1+55.1 months, the renal gammagraphy was normal, and 8 (47,06%) registered fever at diagnosis. Sensitivity for detecting urinary tract infection localization in auxiliary temperature > 38º globular sedimentation rate > 20, C-reactive protein > 5 mg/l and interleukin-6>4pg/ml was 1 and the specificity in C-reactive protein > 70 mg/l and interleuking-6>15 pg/ml was close to 1. Conclusion. Diagnosis of acute pyelonephritis is extremely unlikely in children with urinary infection who do not register high temperature. The analytic parameters studied do not register more sensitivity than high temperature in diagnosing acute pyelonephritis, and only show high specificity in the case of very high serum levels (AU)