Internet, video game and mobile phone addiction in children and adolescents diagnosed with ADHD: A case-control study. / Adicción a Internet, videojuegos y teléfonos móviles en niños y adolescentes: Un estudio de casos y controles.

The use of new technologies has become widespread worldwide. There is increasing concern about "Internet addiction disorder" (IAD), "Internet gaming disorder" (IGD), and "Mobile phone addiction" (MPA). Attention Deficit Hyperactivity Disorder (ADHD) has been associated with IAD and IGD. However, evidence is lacking about the relationship between ADHD and MPA. Naturalistic case-control study. 112 patients (51 children with and 61 children without ADHD) between 7 and 17 years old were compared regarding IAD, IGD, and MPA. We used the TEA questionnaire for the assessment of executive function and ADHD (ATENTO), and the ADITEC questionnaire to get gender-differentiated information for IAD, IGD, and MPA. Female children scored higher on MPA (Mean ± Standard Deviation, M ± SD) (25.93 ±  17.64 vs. 14.77 ±  19.43, p=0.03), while male children scored higher on IGD (30.09 ± 21.65 vs. 12.51 ± 16.61, p < 10^-3). Severity of hyperactivity/impulsivity and IGD were moderately correlated (r=0.349, p=0.013), but the correlation disappeared after controlling for the impact on the social domain as measured by the ATENTO questionnaire (r=171, p=0.250). Most parents are concerned that their children may be addicted to IAD/IGD/MPA. Female gender is associated with MPA, while male gender is associated with IGD. ADHD is a risk factor for developing IAD and IGD. Combined type and predominantly hyperactive/impulsive ADHD are each associated with IGD. Good social adjustment protects against developing IGD. There are gender vulnerabilities for IAD/IGD/MPA. ADHD is a risk factor for IGD, but good social adjustment buffers this association.

El uso de las nuevas tecnologías se ha generalizado a nivel mundial. Hay una creciente preocupación respecto del «trastorno de adicción a Internet¼ (TAI), el «trastorno de juego en Internet¼ (TJI) y la «adicción al teléfono móvil¼ (ATM). El trastorno por el déficit de atención con hiperactividad (TDAH) se ha asociado con el TAI y el TJI. Sin embargo, falta evidencia sobre la relación entre el TDAH y la ATM. Estudio naturalista de casos y controles. Comparación de 112 pacientes (51 niños con el TDAH y 61 niños sin el TDAH) con edades entre 7-17 años respecto del TAI, el TJI y la ATM. Utilizamos el cuestionario de TEA para evaluar la función ejecutiva y el TDAH (ATENTO) y el cuestionario ADITEC para obtener información diferenciada por género para el TAI, el TJI y la ATM. Las niñas obtuvieron puntuaciones más altas en la ATM (desviación típica ± media, DT ± M) (25,93 ± 17,64 vs. 14,77 ± 19,43, p = ,03), mientras que los niños obtuvieron puntuaciones más altas en el TJI (30,09 ± 21,65 vs. 12,51 ± 16,61, p < 10

Adicción a Internet, videojuegos y teléfonos móviles en niños y adolescentes: Un estudio de casos y controles / Internet, video game and mobile phone addiction in children and adolescents diagnosed with ADHD: A case-control study

El uso de las nuevas tecnologías se ha generalizado a nivel mundial.Hay una creciente preocupación respecto del «trastorno de adicción aInternet» (TAI), el «trastorno de juego en Internet» (TJI) y la «adicciónal teléfono móvil» (ATM). El trastorno por el déficit de atención conhiperactividad (TDAH) se ha asociado con el TAI y el TJI. Sin embargo, falta evidencia sobre la relación entre el TDAH y la ATM. Estudionaturalista de casos y controles. Comparación de 112 pacientes (51 niños con el TDAH y 61 niños sin el TDAH) con edades entre 7-17 añosrespecto del TAI, el TJI y la ATM. Utilizamos el cuestionario de TEApara evaluar la función ejecutiva y el TDAH (ATENTO) y el cuestionario ADITEC para obtener información diferenciada por género para elTAI, el TJI y la ATM. Las niñas obtuvieron puntuaciones más altas enla ATM (desviación típica ± media, DT ± M) (25,93 ± 17,64 vs. 14,77 ±19,43, p = ,03), mientras que los niños obtuvieron puntuaciones másaltas en el TJI (30,09 ± 21,65 vs. 12,51 ± 16,61, p < 10-3). Hubo una correlación moderada entre la gravedad de hiperactividad/impulsividady el TJI (r = ,349, p = ,013), pero la correlación desapareció después decontrolar por el impacto en el ámbito social según las mediciones delcuestionario ATENTO (r = 171, p = ,250). A la mayoría de los padres lespreocupa que sus hijos puedan tener el TAI, el TJI o la ATM. El génerofemenino está asociado con la ATM, mientras que el género masculinoestá asociado con el TJI. El TDAH es un factor de riesgo para el desarrollo del TAI y el TJI. El TDAH del tipo combinado y de predominiode hiperactividad/impulsividad están asociados con el TJI. Un buenajuste social protege contra el desarrollo del TJI. Hay vulnerabilidadesde género para el TAI, el TJI y la ATM. El TDAH es un factor de riesgopara el TJI, pero un buen ajuste social amortigua esta asociación. (AU)

The use of new technologies has become widespread worldwide.There is increasing concern about “Internet addiction disorder”(IAD), “Internet gaming disorder” (IGD), and “Mobile phone addiction” (MPA). Attention Deficit Hyperactivity Disorder (ADHD) hasbeen associated with IAD and IGD. However, evidence is lacking aboutthe relationship between ADHD and MPA. Naturalistic case-controlstudy. 112 patients (51 children with and 61 children without ADHD)between 7 and 17 years old were compared regarding IAD, IGD, andMPA. We used the TEA questionnaire for the assessment of executivefunction and ADHD (ATENTO), and the ADITEC questionnaire toget gender-differentiated information for IAD, IGD, and MPA. Femalechildren scored higher on MPA (Mean ± Standard Deviation, M ± SD)(25.93 ± 17.64 vs. 14.77 ± 19.43, p=0.03), while male children scoredhigher on IGD (30.09 ± 21.65 vs. 12.51 ± 16.61, p<10-3). Severity of hyperactivity/impulsivity and IGD were moderately correlated (r=0.349,p=0.013), but the correlation disappeared after controlling for the impact on the social domain as measured by the ATENTO questionnaire(r=171, p=0.250). Most parents are concerned that their children maybe addicted to IAD/IGD/MPA. Female gender is associated with MPA,while male gender is associated with IGD. ADHD is a risk factor fordeveloping IAD and IGD. Combined type and predominantly hyperactive/impulsive ADHD are each associated with IGD. Good socialadjustment protects against developing IGD. There are gender vulnerabilities for IAD/IGD/MPA. ADHD is a risk factor for IGD, butgood social adjustment buffers this association. (AU)

A Latin American and Spanish pediatric gastroenterology group's understanding of cow's milk protein allergy diagnosis and treatment: Results of a survey by the Food Allergy Working Group of the Sociedad Latinoamericana de Gastroenterología, Hepatología y Nutrición Pediátrica. / Conocimiento sobre el diagnóstico y el tratamiento de la alergia a las proteínas de la leche de vaca por un grupo de gastroenterólogos pediatras en Iberolatinoamérica: resultado de la encuesta del Grupo de Trabajo de Alergia Alimentaria de la Sociedad Latinoamericana de Gastroenterología, Hepatología y Nutrición Pediátrica.

INTRODUCTION: There are discrepancies in the diagnosis and management of cow's milk protein allergy (CMPA) in Spain and Latin America. The aim of the present study was to find out how Spanish and Latin American pediatric gastroenterologists diagnose and treat CMPA. MATERIAL AND METHODS: Pediatric gastroenterologists, members of the Sociedad Latinoamericana de Gastroenterología, Hepatología y Nutrición, were invited to fill out a structured survey, the results of which were then compared with the 2012 and 2014 diagnosis and treatment guidelines, respectively. RESULTS: The survey results showed that 17% of the participants follow the diagnostic recommendations based on the published consensus and guidelines. To diagnose non-IgE-mediated CMPA, 15% of the participants utilize IgE-specific skin prick tests, 22% use IgE-specific blood tests, and 45% employ oral food challenges. To diagnose IgE-mediated CMPA the percentages for the same diagnostic methods were 57, 83 and 22%, respectively. Once diagnosis is confirmed, 98% of the participants provide dietary recommendations. In children that are not breastfed, 89% of the participants prescribe an initial extensively hydrolyzed formula, 9% an amino acid formula, 1% a soy formula, and 1% a hydrolyzed rice formula. In patients with IgE-mediated CMPA, 34% of the participants carry out an oral challenge once treatment is completed, 39% according to symptom severity, and 27% in relation to IgE-specific testing. CONCLUSION: CMPA management is diverse and there is poor adherence to the clinical practice guidelines.

Increasing Incidence of Pediatric Eosinophilic Esophagitis in the Southwest of Madrid, Spain.

OBJECTIVES: The incidence of eosinophilic esophagitis is unknown in our area. The aim of our study was to determine the incidence of eosinophilic esophagitis and its possible association with the most frequent absolute annual pollen counts. METHODS: A descriptive retrospective multicenter observational study was designed to calculate the incidence of eosinophilic esophagitis in children aged under 15 years in the southwest region of Madrid, Spain in 2002-2013 (data were provided by the Statistics Institute of Madrid). We collected data on age, sex, clinical presentation, and date of endoscopic diagnosis. Relative risk (RR) was estimated (Stata v.11) using negative binomial regression models to assess the association between incidence and pollen counts (provided by Subiza Clinic). RESULTS: The study population comprised 254 patients (192 male [75.6%], aged 0.5-14.99 years). The clinical presentation was esophageal impaction in 23.6%, dysphagia in 22%, gastroesophageal reflux-like symptoms in 44.9%, and other findings in 9.4%. The annual incidence from 2002 to 2013 per 100 000 children aged <15 years per year was, respectively, 0.81, 1.5, 0.37, 3.17, 3.07, 4.36, 6.87, 7.19, 8.38, 9.05, 9.14, and 9.68. The incidence of eosinophilic esophagitis increased by an average of 19% annually (RR, 1.19; 95%CI, 1.14-1.25; P<.001). In the overall analysis, the relationship between incidence and absolute annual and monthly counts during the pollen seasons of the respective pollen types was analyzed only for Platanus species, which had an RR >1 (1.17 and 1.06, respectively) (P<.05). CONCLUSION: The incidence of diagnosis of pediatric eosinophilic esophagitis increased by an average of 19% annually. No significant association was found between incidence and pollen counts, except for a weak association with Platanus species.

Increasing incidence of pediatric eosinophilic esophagitis in the Southwest of Madrid, Spain

Objectives: The incidence of eosinophilic esophagitis is unknown in our area. The aim of our study was to determine the incidence of eosinophilic esophagitis and its possible association with the most frequent absolute annual pollen counts. Methods: A descriptive retrospective multicenter observational study was designed to calculate the incidence of eosinophilic esophagitis in children aged under 15 years in the southwest region of Madrid, Spain in 2002-2013 (data were provided by the Statistics Institute of Madrid). We collected data on age, sex, clinical presentation, and date of endoscopic diagnosis. Relative risk (RR) was estimated (Stata v.11) using negative binomial regression models to assess the association between incidence and pollen counts (provided by Subiza Clinic). Results: The study population comprised 254 patients (192 male [75.6%], aged 0.5-14.99 years). The clinical presentation was esophageal impaction in 23.6%, dysphagia in 22%, gastroesophageal reflux-like symptoms in 44.9%, and other findings in 9.4%. The annual incidence from 2002 to 2013 per 100 000 children aged <15 years per year was, respectively, 0.81, 1.5, 0.37, 3.17, 3.07, 4.36, 6.87, 7.19, 8.38, 9.05, 9.14, and 9.68. The incidence of eosinophilic esophagitis increased by an average of 19% annually (RR, 1.19; 95%CI, 1.14-1.25; P<.001). In the overall analysis, the relationship between incidence and absolute annual and monthly counts during the pollen seasons of the respective pollen types was analyzed only for Platanus species, which had an RR >1 (1.17 and 1.06, respectively) (P<.05). Conclusion: The incidence of diagnosis of pediatric eosinophilic esophagitis increased by an average of 19% annually. No significant association was found between incidence and pollen counts, except for a weak association with Platanus species

Objetivo: La incidencia de esofagitis eosinofílica es desconocida en nuestra área. El objetivo de nuestro estudio es determinar la incidencia de diagnóstico de esofagitis eosinofílica y su posible asociación con los recuentos absolutos anuales de los pólenes más frecuentes. Métodos: Se diseñó un estudio descriptivo multicéntrico retrospectivo para el cálculo de la incidencia de esofagitis eosinofílica en niños menores de 15 años en el suroeste de la Comunidad de Madrid entre 2002-2013 (datos poblacionales obtenidos del Instituto de Estadística de la Comunidad de Madrid). Se recoge de cada paciente: edad, sexo, presentación clínica y fecha de diagnóstico endoscópico. Se estimó la asociación entre la incidencia y los recuentos polínicos (aportados por la Clínica Subiza) mediante cálculo del riesgo relativo usando modelos de regresión binomial negativa (Stata v.11).Resultados: Se incluyeron 254 pacientes, 75,6% varones (n=192), de edades comprendidas entre 0,5-14,99 años. La presentación clínica fue: impactación esofágica 23,6%, disfagia 22%, síntomas sugerentes de reflujo gastroesofágico 44,9% y otros 9,4%. Las incidencias anuales desde 2002 a 2013 (nº casos/100.000 niños menores de 15 años/año) fueron respectivamente: 0,81; 1,5; 0,37; 3,17; 3,07; 4,36; 6,87; 7,19; 8,38; 9,05; 9,14 y 9,68. La incidencia de esofagitis eosinofílica se incrementó en una media anual de 19% (RR 1,19, 95% IC: 1,14-1,25, p <0,001). En nuestro estudio únicamente existió asociación (RR>1) entre la incidencia y los recuentos polínicos absolutos de Platanus spp anuales y durante los meses de máxima polinización (1,17 and 1,06, respectivamente) (p <0,05).Conclusión: La incidencia de diagnóstico de esofagitis eosinofílica en la edad pediátrica se ha incrementado en una media anual de un 19%. No se encontró una asociación estadísticamente significativa entre la incidencia y los recuentos polínicos, excepto con el Platanus spp aunque ésta fue débil

Trastornos funcionales gastrointestinales / Functional gastrointestinal disorders

No disponible

Conocimiento sobre el uso de fármacos off-label en Pediatría. Resultados de una encuesta pediátrica nacional 2012-2013 (estudio OL-PED) / Results from the 2012-2013 paediatric national survey on off-label drug use in children in Spain (OL-PED study)

INTRODUCCIÓN: Un número elevado de fármacos se prescriben en niños bajo condiciones no autorizadas en ficha técnica (uso off-label). El objetivo principal del estudio es estimar el conocimiento sobre el uso de fármacos fuera de ficha técnica por parte de los pediatras españoles. MATERIAL Y MÉTODOS: Estudio transversal, multicéntrico, descriptivo, de ámbito nacional, mediante encuesta on-line, enviada por correo electrónico a pediatras socios de la Asociación Española de Pediatría o de sus sociedades de Especialidades y Regionales, entre julio del 2012 y marzo del 2013. RESULTADOS: Se recibieron 673 respuestas. Un 71,5% de los pediatras españoles conocen el significado del término off-label, el 61% afirma que prescribe fármacos con indicaciones fuera de ficha técnica y un 47% conoce que dicho uso debe quedar reflejado en la historia clínica. Sin embargo, algo menos de la mitad informa a los padres y solo el 22% lo deja anotado en la historia clínica. CONCLUSIONES: Muchos pediatras no cumplen con la normativa actual con respecto al uso de fármacos en condiciones no autorizadas en ficha técnica. Esta normativa exige: justificar las decisiones de uso off-label y registrar en la historia clínica que se ha obtenido el consentimiento, al menos verbal, de los padres. Se pone de manifiesto una realidad que los pediatras españoles deben cambiar. Mientras tanto, es prioritario continuar con la realización de documentos de consenso y guías de práctica clínica para ampliar la información sobre la eficacia y seguridad de los usos off-label en niños, y poder incorporarlos a las fichas técnicas autorizadas

INTRODUCTION: Off-label drug use is a common practice in paediatrics. The aim of the present study was to estimate the knowledge of Spaniard paediatricians on off-label use. MATERIAL AND METHODS: Cross-sectional, multicentre, descriptive and national study from July 2012 to March 2013 using an on-line questionnaire on off-label use in children. An e-mail was sent to paediatricians who were members of the Spanish Association of Paediatrics (AEP) or its Regional or Paediatric Specialties Societies. RESULTS: Out of 673 responses were received, 75.1% of Spanish paediatricians knew the meaning of off-label use, 61% of them prescribed medicines outside the conditions authorised in their Summary of Product Characteristics (SPC) and 47% knew of the importance of noting the off-label use in the medical record. However, just under half of paediatricians informed parents, and only 22% wrote it down in the medical record. CONCLUSIONS: Most Spanish paediatricians do not meet current regulations regarding off-label use. This regulation demands: justifying the decisions when off-label use is needed, and to write down in the medical record that, at least an oral consent from the parents has been obtained. This study reveals a fact that Spanish paediatricians must change. Meanwhile, it is a priority to continue with the implementation of consensus and clinical guidelines, to obtain more data on the efficacy and safety of off-label drug use in children, and to incorporate them into the SPCien

[Results from the 2012-2013 paediatric national survey on off-label drug use in children in Spain (OL-PED study)]. / Conocimiento sobre el uso de fármacos off-label en Pediatría. Resultados de una encuesta pediátrica nacional 2012-2013 (estudio OL-PED).

INTRODUCTION: Off-label drug use is a common practice in paediatrics. The aim of the present study was to estimate the knowledge of Spaniard paediatricians on off-label use. MATERIAL AND METHODS: Cross-sectional, multicentre, descriptive and national study from July 2012 to March 2013 using an on-line questionnaire on off-label use in children. An e-mail was sent to paediatricians who were members of the Spanish Association of Paediatrics (AEP) or its Regional or Paediatric Specialties Societies. RESULTS: Out of 673 responses were received, 75.1% of Spanish paediatricians knew the meaning of off-label use, 61% of them prescribed medicines outside the conditions authorised in their Summary of Product Characteristics (SPC) and 47% knew of the importance of noting the off-label use in the medical record. However, just under half of paediatricians informed parents, and only 22% wrote it down in the medical record. CONCLUSIONS: Most Spanish paediatricians do not meet current regulations regarding off-label use. This regulation demands: justifying the decisions when off-label use is needed, and to write down in the medical record that, at least an oral consent from the parents has been obtained. This study reveals a fact that Spanish paediatricians must change. Meanwhile, it is a priority to continue with the implementation of consensus and clinical guidelines, to obtain more data on the efficacy and safety of off-label drug use in children, and to incorporate them into the SPC.

Hospitalización por gastroenteritis aguda de etiología bacteriana en menores de 5 años / Bacterial acute gastroenteritis requiring hospital admission in children under 5 years

La gastroenteritis aguda (GEA) es una causa frecuente de hospitalización en la edad pediátrica. Aunque la etiología viral es la predominante, las bacterias pueden ser un agente importante en algunas épocas del año. Se lleva a cabo un estudio descriptivo prospectivo de las GEA de origen bacteriano que requirieron hospitalización en niños menores de 5 años en un hospital de un área suburbana de Madrid, desde enero de 2005 hasta diciembre de 2010. La etiología bacteriana es responsable del 9,3% de los ingresos por GEA en menores de 5 años, con una incidencia de 0,9 ingresos a causa de una GEA bacteriana por 1.000 menores de 5 años, aunque se ha constatado un descenso en 2005 respecto al resto de los años de estudio. El germen más frecuentemente implicado fue Salmonella spp. No se han encontrado parámetros clínicos que diferencien claramente las gastroenteritis bacterianas de las víricas (AU)

Acute gastroenteritis (AGE) is a common cause of hospitalization in the pediatric age. Although viral etiology is predominant, bacteria can occupy an important place at certain times of the year. Between January 2005 and December 2010 a descriptive and prospective survey was carried out analyzing AGE of bacterial origin requiring hospital admission, in children younger than five years in a hospital of a suburban area of Madrid. Bacterial etiology is responsible for 9.3% of revenue by AGE in less than five years, with an hospitalized incidence of 0.9 per thousand under the age of 5, having a decrease from 2005 to the rest of their years studied. Most frequently bacteria isolated was Salmonella spp. We didn't found clinical parameters to distinguish clearly between bacterial or viral gastroenteritis (AU)

Empleo de probióticos y prebióticos en pediatría / No disponible

No disponible

[Family impact of rotavirus gastroenteritis in children under two years]. / Impacto familiar de la gastroenteritis por rotavirus en menores de dos años.

INTRODUCTION: Acute gastroenteritis (AGE) in infants has a significant impact on the quality of life of their parents. MATERIAL AND METHODS: Cross-sectional study on the sociological family impact related to rotavirus AGE in children under 2 years. The study was carried out in 25 hospitals and 5 primary care centres in Spain. Sociodemographic, epidemiological and clinical data were recorded, as well as the symptomatology of AGE and its severity measured by the Clark scale. Stool samples were tested to determine rotavirus positive (RV+) or negative (RV-). The parents were asked to complete a a family impact questionnaire. RESULTS: Stool specimens were tested in 1087 AGE cases (584 RV+ vs 503 RV-). The 99.5 % of parents whose children were RV+ reported more worries vs. the 97.7 % of RV-, and RV+ had a higher importance score (p < 0.05). A higher percentage of RV+ parents and those with a high importance score reported more time dedicated to dehydration treatment (p < 0.05). The 82.5 % vs. 73.9 % had disruption of their household tasks, with more importance scores (p < 0.05). RV+ had a higher percentage and importance score than RV- ones in all aspects of their child's AGE symptoms, except loss of appetite. CONCLUSION: AGE produces important dysfunctional experiences in daily family life. According to parental perceptions, RV+ produces greater worries and dysfunctions in child behaviour.

Vacunación frente a rotavirus / Vaccination against rotavirus

No disponible

No disponible

Gastroenteritis aguda nosocomial e infección asintomática por rotavirus y astrovirus en niños hospitalizados / Nosocomial gastroenteritis and asymptomatic rotavirus and astrovirus infection in hospitalized children

Antecedentes: La gastroenteritis nosocomial es un problema frecuente en las unidades de hospitalización pediátricas, donde el 20-50 por ciento de los episodios por rotavirus y astrovirus son de origen nosocomial. Objetivo: Describir en nuestro medio la incidencia de gastroenteritis nosocomial por rotavirus y astrovirus y de eliminación fecal asintomática de estos virus e identificar los serotipos G de los rotavirus detectados. Métodos: Estudio prospectivo de los niños ingresados durante un año en la unidad de lactantes con seguimiento de la aparición de síntomas de gastroenteritis y estudio periódico de heces para detección de antígeno de rotavirus y de astrovirus por enzimoinmunoanálisis (EIA). En los pacientes con gastroenteritis se realizó también coprocultivo, estudio de adenovirus por EIA y de calicivirus por reacción en cadena de la polimerasa (PCR) y análisis de los serotipos G de los rotavirus por EIA con anticuerpos monoclonales. Resultados: De los 666 niños ingresados sin diarrea, 60 presentaron gastroenteritis nosocomial (9/100 pacientes ingresados y 1,75 por 100 días de estancia hospitalaria): rotavirus en 34 casos (5/100 pacientes) y astrovirus en 2 (0,3/100 pacientes). En 27 pacientes de los 329 estudiados sin diarrea se detectó eliminación viral: rotavirus en 23 pacientes y astrovirus en cuatro; en 13 (4 por ciento) en el ingreso y en 14 (4,2 por ciento) pasadas 72 h (infección nosocomial asintomática). No hubo diferencia en los serotipos G detectados entre los casos de gastroenteritis nosocomial y los de origen comunitario. Conclusiones: Se confirma la importancia de la etiología viral en la gastroenteritis nosocomial y se valora la eliminación fecal asintomática de rotavirus como uno de los factores de transmisión de esta infección (AU)

[Nosocomial gastroenteritis and asymptomatic rotavirus and astrovirus infection in hospitalized children]. / Gastroenteritis aguda nosocomial e infección asintomática por rotavirus y astrovirus en niños hospitalizados.

BACKGROUND: Nosocomial gastroenteritis is frequent in pediatric hospital wards. Between 20% and 50% of gastroenteritis cases caused by rotavirus and astrovirus are of nosocomial origin. OBJECTIVE: To determine the incidence of nosocomial rotavirus and astrovirus gastroenteritis in our environment, the incidence of asymptomatic infection with these viruses, and to identify the G serotypes of the rotaviruses detected. METHODS: We performed a prospective study of all children under 2 years of age admitted to a neonatology unit over a 1-year period who were followed-up for the presence of diarrhea and periodic study of feces to detect the presence of rotavirus and astrovirus antigens by enzyme immunoassay (EIA). Patients with gastroenteritis also underwent bacteria stool culture, adenovirus detection by EIA, calcivirus detection by polymerase chain reaction, and analysis of rotavirus G serotypes by EIA with monoclonal antibodies. RESULTS: Of 666 children admitted without diarrhea, 60 presented nosocomial gastroenteritis (9 % of patients admitted and 1.75 per 100 days of hospital stay): 34 presented rotavirus (5 % of patients) and two presented astrovirus (0.3 % of patients). Of the 329 patients without diarrhea who were studied, viral elimination was detected in 27: rotavirus in 23 patients and astrovirus in four. Viral infection was detected on admission in 13 patients (4 %) and after 72 hours in 14 patients (4.2 %) (asymptomatic nosocomial infection). No differences in the distribution of rotavirus G serotypes were observed between community-acquired and nosocomial gastroenteritis. CONCLUSIONS: These data confirm the importance of viral etiology in nosocomial gastroenteritis and allow us to evaluate asymptomatic fecal elimination of rotavirus as one of the factors in the transmission of this infection.

[Silent celiac disease: exploring the iceberg in the school-aged population]. / Enfermedad celíaca silente: explorando el iceberg en población escolar.

BACKGROUND: Epidemiological studies have shown a high prevalence of silent celiac disease (CD) among unselected pediatric populations and a low ratio of diagnosed to undiagnosed CD. OBJECTIVES: To quantify the prevalence of silent CD, to assess the clinical features of subclinical CD and to determine the total prevalence of CD (silent plus symptomatic cases). METHODS: We determined total serum IgA, IgA antiendomysial antibodies (EMA) and IgG antigliadin antibodies (IgG AGA), if IgA deficiency was found, in schoolchildren aged 10-12 years from health district IX in Madrid. RESULTS: A total of 3,378 schoolchildren (47.8 % of the eligible population) were studied. Fifteen were EMA-positive and one child with IgA deficiency was IgG AGA-positive. CD was confirmed by intestinal biopsy in 12 children, representing a prevalence of undiagnosed CD of 1/281. Of these 12 children, 7 showed clinical features of CD. The most frequent symptom was iron-deficiency, followed by recurrent aphthous stomatitis and mild malnutrition. Before the start of this study, CD had been diagnosed in seven children from the same population, which would increase the total prevalence of the disease to 1/220 with an estimated ratio of diagnosed to undiagnosed CD of 1 to 3.5. CONCLUSIONS: We confirm the high prevalence of silent celiac disease among the school-aged population. This ratio is one of the highest published and could be due to a high diagnostic suspicion for CD among pediatricians in our health district. Greater awareness of the minor symptoms of CD would reduce the number of patients with undiagnosed CD.

Enfermedad celíaca silente: explorando el iceberg en población escolar / Silent cardiac disease: exploring the iceberg in the school-aged population

Fundamento: Los estudios epidemiológicos realizados sobre población infantil no seleccionada han demostrado una elevada prevalencia de enfermedad celíaca silente y una baja relación de enfermedad celíaca conocida frente a no diagnosticada. Objetivos: Realizar un cribado de enfermedad celíaca silente en población escolar, caracterizar clínicamente a estos pacientes y valorar su prevalencia global (casos silentes más sintomáticos). Métodos: Se determinaron anticuerpos antiendomisio (EMA), inmunoglobulina A (IgA) sérica y anticuerpos antigliadina IgG (AGA IgG), si existía déficit de IgA, a los escolares de 10 a 12 años del área IX de Madrid. Resultados Se han estudiado 3.378 niños (47,8% de la muestra). Quince fueron EMA positivos y uno déficit de IgA tuvo AGA IgG positivos. La enfermedad celíaca se confirmó mediante biopsia intestinal en 12 niños, lo que representa una prevalencia de enfermedad celíaca silente de 1/281. Siete de los 12 niños mostraban hallazgos clínicos, entre los que los más frecuentes fueron ferropenia, aftas orales recurrentes y malnutrición leve. Previamente a este estudio de detección habían sido diagnosticados 7 enfermos celíacos en la misma población, con lo que la prevalencia global calculada ascendería a 1/220 y la relación entre enfermedad celíaca conocida y no diagnosticada sería de 1/3,5. Conclusiones: Se confirma una elevada prevalencia de enfermedad celíaca silente en nuestro medio. La relación entre enfermedad celíaca conocida y silente es una de las mayores de la bibliografía y podría relacionarse con un importante nivel de alerta frente a esta enfermedad por parte de los pediatras de nuestra área de salud. Un mejor conocimiento de los síntomas menores de la enfermedad celíaca disminuirá el número de casos de enfermedad celíaca no diagnosticada (AU)

Infecciones por el virus parainfluenza tipo 4 / Parainfluenza virus type 4 infections

Objetivo: Describir las características clínicas y epidemiológicas de las infecciones por virus parainfluenza humano tipo 4 (VPIH-4) en pacientes pediátricos. Métodos: Se estudiaron los pacientes hospitalizados o atendidos en el servicio de urgencias con el diagnóstico de infección respiratoria de vías respiratorias inferiores. Las variables clínicas estudiadas fueron edad, sexo, diagnóstico clínico, temperatura corporal, saturación de oxígeno en sangre arterial (SaO2), resultado de la radiografía de tórax y duración de la hospitalización. Las muestras obtenidas mediante aspiración nasofaríngea se estudiaron mediante inmunofluorescencia indirecta (IFI), cultivo celular y una nueva técnica de reacción en cadena de la polimerasatranscripción inversa (RT-PCR) múltiple, capaz de detectar en la misma reacción los 4 tipos de virus parainfluenza. Resultados: Se analizaron 230 muestras correspondientes a 191 pacientes. En el 35,1% de los episodios se detectó algún virus parainfluenza: el 37,3% correspondió al VPIH-1, el 10,4% al VPIH-2, el 38,9% al VPIH-3 y en el 13,4% se identificó el VPIH-4. Se amplificó ARN del virus parainfluenza tipo 4 en 10 muestras correspondientes a 9 pacientes. Todos ellos excepto uno eran menores de 2 años, con unos límites de edad entre 26 días y 23 meses. El diagnóstico clínico fue bronquiolitis o bronquitis sibilante, que en uno de ellos se acompañó de infiltrado pulmonar. Precisaron ingreso hospitalario 6 pacientes, con una SaO2 media de 89,5% y una estancia media de 7,6 días. Discusión: Es la primera vez que se describe la circulación del VPIH-4 en España. Las infecciones ocasionadas por este virus no son tan leves como se había descrito inicialmente. La utilización de una RT-PCR múltiple permite diagnosticar infecciones respiratorias por VPIH-4 que de otra manera pasarían desapercibidas (AU)

[Parainfluenza virus type 4 infections]. / Infecciones por el virus parainfluenza tipo 4.

OBJECTIVE: To describe the clinical and epidemiological characteristics of parainfluenza virus type 4 infections in pediatric patients. METHODS: Inpatients and outpatients with lower respiratory tract infections were studied. Recorded data were age, sex, clinical diagnosis, temperature, oxygen saturation, chest radiograph and length of hospital stay. Nasopharyngeal aspirates were studied through indirect immunofluorescence, tissue culture and a new multiplex reverse-transcriptase polymerase chain reaction (RT-PCR) able to identify the four types of human parainfluenza virus in the same reaction. RESULTS: Two hundred thirty specimens from 191 patients were analyzed. Parainfluenza viruses were diagnosed in 35.1 %: 37.3 % type 1, 10.4 % type 2, 38.9 % type 3 and 13.4 % type 4. RNA from parainfluenza virus type 4 was amplified in 10 aspirates from nine patients. Of these, all except one were aged less than two years (range: 26 days to 23 months). The clinical diagnosis was bronchiolitis or wheezing associated with lower respiratory tract infection. Six patients required admission, with a mean oxygen saturation of 89.5 % and a mean length of hospital stay of 7.6 days. DISCUSSION: This is the first description of the characteristics of parainfluenza virus type 4 in Spain. Infections associated with this virus are not as mild as previously thought. Application of a multiplex RT-PCR allows identification of respiratory infections due to parainfluenza virus type 4 that would otherwise be underdiagnosed.

[The consumption of food of animal origin distinct from milk: meat, fish, eggs in the school-age population of the community of Madrid. The Food Consumption and Nutritional Status of the School-Age Population of the Autonomous Community of Madrid Group]. / Ingesta de alimentos de procedencia animal distintos de la leche: carnes, pescados y huevos, en la población escolar de la Comunidad de Madrid. Grupo CAENPE.

The aim of this study was to assess the intake of foods of animal origin other than milk, as well as their role in the diet of children, in a representative sample of a school-aged population from the Community of Madrid (CAENPE study). A 4 day assessment of the dietary intake was conducted by applying a combination of the methods of 24-hour recall and a written record of the estimated consumption. We studied 2,608 schoolchildren between the ages of 6 and 14 years. The subjects were divided into groups according to age and sex. We found that the average meat intake was 213 +/- 87 g/person/day. The consumption of meat was significantly higher in boys (p < 0.05) and increased with age both in boys (p < 0.001) and girls (p < 0.05). Meat provided 40% of the saturated fat, 34% of the cholesterol and 33.5% of the protein in the diet. Fish intake was 77 +/- 64 g/person/day, with higher consumption in boys (p < 0.05) and with no influence of age. Fish supplied 11% of the dietary protein and only 1.2% of the saturated fat. Egg consumption was 31 +/- 20 g/day/person, which represents 3 eggs per week. The consumption of eggs was also higher in boys than in girls (p < 0.05) and provides 28% of the dietary cholesterol. We conclude that meat provides more than one third of the dietary protein and alone covers the RDA for protein. In addition, meat also contributes the highest amount of dietary saturated fat and cholesterol. Egg and fish intake is adequate; hence, it would be desirable to reduce the excessive meat intake in order to equilibrate the macronutrients and cholesterol supplied by the diet.