Los tubos de timpanostomía y la adenoidectomía mejoran la audición a corto plazo en las otitis medias serosas / Timpanostomy tubes and adenoidectomy improve hearing in the short term in children with otitis media with effusion

Las otitis medias serosas son muy frecuentes durante la infancia: un 90% de los niños tienen al menos un episodio en los primeros diez años de vida. La mayoría se resuelven espontáneamente en los primeros tres meses, pero entre un 5 y un 10% duran más de un año y entre un 30 y un 40% de los niños tienen episodios recurrentes. En esta revisión sistemática se examina la efectividad de las distintas opciones de tratamiento quirúrgico de la otitis media serosa a cualquier edad. Se trata de una revisión sistemática que responde a cinco preguntas clínicas. Se define adecuadamente la población y las intervenciones objeto de estudio con unas preguntas clínicamente bien definidas. Sin embargo, existe riesgo de sesgo de selección al analizar solo artículos en lengua inglesa y no realizarse una búsqueda exhaustiva. Si se compara con la actitud expectante o la miringotomía, hay una fuerte evidencia de que los tubos de timpanostomía disminuyen el derrame (el 32% en un año y el 13% a los dos años) y producen mejoría de la audición (10 decibelios a los 4-6 meses) pero no influyen en el desarrollo del lenguaje a más largo plazo. Los niños que padecen otitis media serosa bilateral de tres o más meses de duración y pérdida de audición documentada son el grupo de pacientes donde deberíamos plantearnos el tratamiento quirúrgico con tubos de timpanostomía (AU)

The otitis media with effusion is a very common condition during childhood: 90% of children have at least one episode in the first ten years of life. Most resolve spontaneously in the first three months, but between 5 and 10% last more than a year and between 30 and 40% of children have recurrent episodes. In this systematic review the effectiveness of the various options for surgical treatment of otitis media with effusion at any age is examined. This is a systematic review that meets five clinical questions. Population and interventions under study are properly defined and the clinical questions are well constructed. However there is a risk of selection bias because they analyze only articles in English and the search is not exhaustive. If you compare expectant attitude versus myringotomy, there is strong evidence that tympanostomy tubes decrease effusion (32% in one year and 13% at two years) and produce improvement in hearing (10 decibel 4-6 months) but does not affect language development in the longer term. Children with otitis media with bilateral effusion lasting three or more months and documented hearing loss, are the group of patients where we should consider surgical treatment with tympanostomy tubes (AU)

[Relationship between lipid profile and body mass index. Five-year follow-up in children aged 6-11 years old. The Rivas-Vaciamadrid study]. / Relación entre el perfil lipídico y el índice de masa corporal. Seguimiento de los 6 a los 11 años. Estudio Rivas-Vaciamadrid.

BACKGROUND: To study the relationship between lipid profile and body mass index (BMI) in children after a 5-year follow-up. METHOD: A total of 281 children were evaluated at the ages of 6 and 11 years. Total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and apoproteins A1 (Apo A) and B100 (Apo B) were measured. Low-density lipoprotein cholesterol (LDL-C) was determined and the Apo B/Apo A, TC/HDL-C, LDL-C/HDL-C indexes, and the atherogenic index were calculated. BMI was also calculated (BMI 5 kg/m2). Evolution parameters were calculated (EVO 5 value 11 years - value 6 years). Associations between BMI and lipid profile were studied. RESULTS: The prevalence of obesity (according to the criteria of the International Obesity Task Force) was 4.98 % (6 years) and 16,72 % (11 years). In children who were in the fourth BMI quartile at the age of 11 years, LDL-C/HDL-C and TC/HDL-C levels were significantly higher and than those in children in the first quartile but HDL-C and Apo A levels were lower. A significant positive correlation was found between the evolution of BMI and the four indexes studied and TG, but this correlation was negative for HDL-C and Apo A. The evolution of the indexes was positive in 11-year-old obese children and negative in nonobese children. CONCLUSIONS: Lipid profile was worse in 11-year-old children in the fourth BMI quartile than in the remaining children. Obese children had higher values of the indexes studied, supporting the importance of obesity as a cardiovascular risk factor.

Relación entre el perfil lipídico y el índice de masa corporal. Seguimiento de los 6 a los 11 años. Estudio Rivas-Vaciamadrid / Relationship between lipid profile and body mass index. Five-year follow-up in children aged 6-11 years old. The Rivas-Vaciamadrid study

Antecedentes Estudiar la relación entre perfil lipídico e índice de masa corporal en niños tras un seguimiento de 5 años. Método Se estudiaron 281 niños a los 6 y 11 años. Se midió el colesterol total (CT), triglicéridos (TG), colesterol de las lipoproteínas de alta densidad (c-HDL) y apoproteínas A1 (Apo A) y B100 (Apo B). Se calculó el colesterol de las lipoproteínas de baja densidad (c-LDL) e índices Apo B/Apo A, CT/c-HDL, c-LDL/c-HDL y aterogénico. La evolución de los parámetros se calculó: valor a los 11 años-valor a los 6. Se calculó el índice de masa corporal (IMC 5 kg/m 2) y se estudió su relación con el perfil lipídico. Resultados La prevalencia de obesidad (según criterios del International Obesity Task Force) fue del 4,98 % (6 años) y del 16,72 % (11 años). A los 11 años, existen valores significativamente más altos de CT/c-HDL, c-LDL/c-HDL y más bajos de c-HDL y Apo A en niños del cuarto cuartil de IMC. Se encontró una correlación significativa positiva entre la evolución del IMC y la de los 4 índices estudiados y los TG, y negativa para c-HDL y Apo A. La evolución de los índices estudiados presentó un valor positivo en los niños obesos a los 11 años y negativo en los no obesos. Conclusiones Existe un peor perfil lipídico en niños que están en el cuarto cuartil de IMC a los 11 años, así como un aumento de los índices estudiados en niños obesos reforzando el papel de la obesidad como factor de riesgo cardiovascular

Background To study the relationship between lipid profile and body mass index (BMI) in children after a 5-year follow-up. Method A total of 281 children were evaluated at the ages of 6 and 11 years. Total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and apoproteins A1 (Apo A) and B100 (Apo B) were measured. Low-density lipoprotein cholesterol (LDL-C) was determined and the Apo B/Apo A, TC/HDL-C, LDL-C/HDL-C indexes, and the atherogenic index were calculated. BMI was also calculated (BMI 5 kg/m 2). Evolution parameters were calculated (EVO 5 value 11 years ­ value 6 years). Associations between BMI and lipid profile were studied. Results The prevalence of obesity (according to the criteria of the International Obesity Task Force) was 4.98 % (6 years) and 16,72 % (11 years). In children who were in the fourth BMI quartile at the age of 11 years, LDL-C/HDL-C and TC/HDL-C levels were significantly higher and than those in children in the first quartile but HDL-C and Apo A levels were lower. A significant positive correlation was found between the evolution of BMI and the four indexes studied and TG, but this correlation was negative for HDL-C and Apo A. The evolution of the indexes was positive in 11-year-old obese children and negative in nonobese children. Conclusions Lipid profile was worse in 11-year-old children in the fourth BMI quartile than in the remaining children. Obese children had higher values of the indexes studied, supporting the importance of obesity as a cardiovascular risk factor

[High frequency ventilation in the newborn. Study of 27 cases]. / Ventilación de alta frecuencia en el recién nacido. Estudio de 27 casos.

The clinical histories of 27 neonates ventilated with high frequency respirators (Volumetric Diffusive Respirator VDR-2) have been analyzed in order to evaluate the efficiency of this type of ventilation in neonatal pathology. The average gestational age of these patients was 32 +/- 4 weeks. Most of them (70%) presented respiratory distress due to hyaline membrane disease. Of the remaining cases, three (11%) presented with congenital diaphragmatic hernia, two with pulmonary hypertension, two with meconium aspiration syndrome, one with Group B Streptococal sepsis/shock and one with case diaphragmatic agenesia. Between two and six hours after initiation of high frequency ventilation (HFV), pH, paCO2 and pO2 improved significantly in relationship to former values (p < 0.05- p < 0.001), reaching values in the normal range at 6.5 +/- 14 hours regarding pH, 30 +/- 50 hours regarding paCO2 and 6.5 +/- 10 hours regarding paO2. No hemodynamic modification could be attributed to this procedure. The principal complications were ectopic air (62%) and necrotizing tracheobronchitis (TBN) (25%). Bronchopulmonary dysplasia (BDP) was diagnosed in 20% of the cases, ductus (DAP) in 33% of the cases and intracraneal hemorrhage in 25% of the cases. Mortality was 70%. High frequency ventilation is an alternative procedure to conventional ventilation in this group of neonates. It produces an important number of favorable responses, but has complications that can not be overlooked.

PIP: Clinical records of 27 newborns treated with high frequency ventilation in a hospital neonatal service in Madrid were retrospectively studied. High frequency ventilation is a technique with specific indications that has recently been applied in some neonatal pathologies as an alternative to conventional ventilation. The respirators, model 2 Volumetric Diffusive Respirators, were used in 24 of the 27 cases because of failure of conventional ventilation. The 27 newborns weighed an average of 1850 +or- 944 g and ranged from 900 to 4000 g. Their average gestational age was 32 +or- 4 weeks, and the range was 26-42 weeks. 19 had respiratory difficulties stemming from hyaline membrane disease, 3 had congenital diaphragmatic hernias, 2 had pulmonary hypertension, and one each had meconium aspiration syndrome, septic shock from group B streptococcus, and diaphragmatic agenesia. 66% were delivered by cesarean. The pH, paCO2, and paO2 improved significantly between 2 and 6 hours after initiation of HFV treatment. Values in the normal range were reached at 6.5 +or- 14 hours for pH, 30 +or- 50 hours for paCO2, and 6.5 +or- 10 hours for paO2. No hemodynamic modifications were attributed to HFV. The most significant complications were ectopic air (62%) and necrotizing tracheobronchitis (25%). Broncopulmonary dysphasia was diagnosed in 20%, ductus in 33%, and intracraneal hemorrhage in 25%. The case fatality rate was 70%. Ten newborns improved definitively with HFV and proceeded to conventional ventilation. Two later succumbed to other causes. The study showed that HFV can lead to serious complications and should be applied with great prudence despite it great potential benefit.