[Utility of distinct urinalysis parameters in the diagnosis of urinary tract infections]. / Utilidad de los distintos parámetros del perfil urinario en el diagnóstico de infección urinaria.

A review of the scientific evidence available on the validity of urinalysis in the diagnosis of urinary tract infection in childhood is presented. Numerous studies evaluating the validity of distinct urinalysis parameters have been published. Although many of these studies have methodological deficiencies, the indicators of validity evaluated in the various systematic reviews can be assumed to be applicable to clinical practice; however, the grade of evidence supporting these studies is less than optimal. There are some parameters or combinations of parameters that have better sensitivity or specificity, but few present sufficiently high positive and negative predictive values simultaneously to form the exclusive basis for diagnosis. Bacteriuria presents certain advantages over other parameters, although this test is not routinely available and loses validity in non-sterile samples. Nevertheless, there are several circumstances that can modify the applicability of these tests in clinical practice: the technique used in urine collection, the patient's age and clinical status, and especially the degree of urgency with which the diagnosis is required.

Utilidad de los distintos parámetros del perfil urinario en el diagnóstico de infección urinaria / Utility of distinct urinalysis parameters in the diagnosis of urinary tract infections

Se presenta una revisión de la evidencia científica disponible sobre la validez del perfil urinario en el diagnóstico de infección urinaria en la infancia. Existen múltiples estudios de evaluación de la validez de distintos parámetros del análisis de orina. Aunque muchos de ellos tienen deficiencias metodológicas, podemos asumir que los indicadores de validez estimados en las distintas revisiones sistemáticas parecen aplicables a la práctica clínica, a pesar de que el grado de evidencia en que se sustentan no sea el óptimo. Hay algunos parámetros o combinaciones de parámetros que tienen una mejor sensibilidad o especificidad, aunque pocos tienen al mismo tiempo valores predictivos positivo y negativo lo bastante buenos como para basar el diagnóstico exclusivamente en ellos. La bacteriuria presenta ciertas ventajas frente a otros parámetros aunque no es una prueba habitualmente disponible, y en muestras no estériles pierde validez. Sin embargo, hay diversas circunstancias que pueden condicionar la aplicabilidad de estas pruebas en la práctica clínica: la técnica empleada en la recogida de orina, la edad y la situación clínica del paciente y, en especial, el grado de urgencia con el que se necesita el diagnóstico

A review of the scientific evidence available on the validity of urinalysis in the diagnosis of urinary tract infection in childhood is presented. Numerous studies evaluating the validity of distinct urinalysis parameters have been published. Although many of these studies have methodological deficiencies, the indicators of validity evaluated in the various systematic reviews can be assumed to be applicable to clinical practice; however, the grade of evidence supporting these studies is less than optimal. There are some parameters or combinations of parameters that have better sensitivity or specificity, but few present sufficiently high positive and negative predictive values simultaneously to form the exclusive basis for diagnosis. Bacteriuria presents certain advantages over other parameters, although this test is not routinely available and loses validity in non-sterile samples. Nevertheless, there are several circumstances that can modify the applicability of these tests in clinical practice: the technique used in urine collection, the patient's age and clinical status, and especially the degree of urgency with which the diagnosis is required

[Long-term development of children with Schönlein-Henoch purpura associated with anti-neutrophil cytoplasmic antibodies]. / Evolución a largo plazo de los niños con púrpura de Schönlein-Henoch asociada a anticuerpos anticitoplasma de neutrófilo (ANCA).

OBJECTIVE: The purpose of this study was to assess the frequency of antineutrophil cytoplamic antibodies (ANCA) in Schönlein-Henoch purpura (SHP) and its long-term significance. PATIENTS AND METHODS: IgG and IgA classes of ANCA were studied by indirect immunofluorescence (IIF) and IgG-ANCA against myeloperoxidase (MPO) and against proteinase-3 (PR-3) were determined by ELISA in 50 children with SHP. Eight (16%) of the patients had renal involvement during the acute phase, but none had a permanent nephropathy after a 7-17 year follow-up. RESULTS: Positive IgG ANCA were found in 5 (10%) of the cases and only one of these children also had IgA ANCA. The ELISA against MPO and P-3 was negative in all patients. None of the 5 patients with ANCA showed nephropathy during the acute phase nor relapses or permanent nephropathy. CONCLUSIONS: A minority of children with SHP are positive for ANCA and, in the absence of nephropathy, this is not associated with a bad long-term prognosis.

[Current trends in breastfeeding in Valladolid]. / Tendencias actuales de la lactancia materna en Valladolid.

Authors studied influence of several factors on the election of infant feeding type, and breast feeding incidence and its duration. Two hundred questionnaires were obtained from mothers living within Valladolid. 76% intended to breast-feed. Breast-feeding was not modified by mothers' age, geographic area, instruction, economic-social class, tradition, desired pregnancy, maternal opinion about lactation, aesthetic impairment, maternal or neonatal pathology, husband advice and medical opinion. Nevertheless, frequency of bottle feeding was significantly increased by medical advice contrary to breast-feeding, absence of husband's opinion, hospital admission of the newborn and absence of feeding type distinction by mother. Duration of breast-feeding was longer in low level cultural classes, without differences of mother's age or economic condition. Motives for election were: breast-feed was considered more nutritive (78%), family tradition (10%), and medical advice (8%). Reasons for suspension were: Hypogalactia (70%), medical advice (16%), maternal disease (7%), child disease (3%) and maternal work (3%).

[Secondary carbohydrate intolerance. Evolutive follow-up (author's transl)]. / Intolerancia secundaria a hidratos de carbono. Control evolutivo.

This study reports 70 children suffering from malabsorption and/or carbohydrate intolerance followed for at least twelve months. Mono and dysaccharide overload curves are considered as very valuable tests together with the clinical signs. These must be carefully observed during the tests and after supression of the malabsorbed sugar. Reliability of the overload tests in the follow-up is pointed out. Variations in the normalization time of the curves for each carbohydrate are determined. Finally 90 min. is considered as an advisable end-point for overload tests.