Síndrome de Swyer-James-MacLeod. Presentación de 2 casos y consideraciones clínicas / Swyer-James-MacLeod syndrome. Two case reports and a clinical review

No disponible

Síndrome de Chilaiditi. Una imagen vale más que mil palabras / Chilaiditi syndrome. An image is better than thousand words

Se presenta el caso de una niña de 6 años que refería un dolor abdominal leve de 2 meses de evolución, en la que la radiografía de tórax permitió hacer el diagnóstico de síndrome de Chilaiditi (AU)

We report the case of a 6-year-old girl who was recounting abdominal slight pain of 2 months of evolution, in which the X-ray picture of thorax allowed us to do the diagnosis of Chilaiditi's syndrome (AU)

Infecciones virales de vías respiratorias en los primeros seis meses de vida / Viral respiratory tract infections in the first six months of life

Antecedentes: El virus respiratorio sincitial (VRS) y otros virus son causas conocidas de hospitalización en lactantes. Menos conocido es el patrón de virus en infecciones extrahospitalarias en menores de 6 meses. Objetivo: El objetivo de este estudio es describir las características clínicas y los factores epidemiológicos asociados con las infecciones respiratorias virales de ámbito extrahospitalario en menores de 6 meses. Pacientes y métodos: Estudio prospectivo en cohorte de niños de las áreas 8 y 9 de Madrid controlados desde el nacimiento mediante llamadas telefónicas quincenales durante una temporada invernal. Se registraron datos clínicos y epidemiológicos en cuestionarios prediseñados. Se exploró y recogió el aspirado nasofaríngeo (ANF) cuando el paciente presentó sintomatología compatible con una infección respiratoria. El diagnóstico de los virus más comunes se realizó con inmunofluorescencia directa (IFD) y amplificación genómica (PCR). Resultados: Fueron seleccionados 316 recién nacidos. Se realizaron 1.865 llamadas telefónicas (mediana 4), y 106 visitas, en 89 de las cuales se confirmó la enfermedad. Los síntomas más frecuentes fueron rinitis (91 %) y tos (69 %). El diagnóstico clínico principal fue infección respiratoria de vías altas (82 %); 17 de 72 ANF realizados (23,2 %) fueron positivos. Se detectaron rinovirus (41,1 %) y VRS (35,2 %). Ingresaron un 16 % (17/106) de los niños atendidos por enfermedad (el 5,3 % de la cohorte), diagnosticados de síndrome febril y de bronquiolitis. No encontramos ningún factor epidemiológico asociado con la infección respiratoria viral en los casos positivos. Conclusiones: En nuestro medio las infecciones respiratorias de los lactantes son en su mayoría banales y no precisan atención hospitalaria. El rinovirus y el VRS son los principales agentes etiológicos. No se encontraron factores epidemiológicos relacionados con la infección respiratoria asociada a virus (AU)

Background: Respiratory syncytial virus and Influenza virus infections are known causes of hospital admission in infants. It is less well known the pattern of virus infections in infants under 6 months of age in the outpatient setting. Objective: To describe the clinical and epidemiological pattern of community-acquired viral respiratory infections in infants under 6 months. Patients and methods: A cohort of infants from the 8 and 9 Madrid Health Districts was followed by telephone calls every two weeks since birth during the epidemic winter season. Clinical and epidemiological data were collected in pre-designed questionnaires. Nasopharyngeal aspirate was obtained in every patient with symptoms compatible with respiratory infection. Diagnosis of the more common virus was made with direct immunofluorescence and nucleic acid amplification test (PCR). Results: Were recruited 316 newborns. The 1,865 phone calls made (median 4 for every child), produced 106 visits, and the illness confirmed in 89 illness. Rhinitis (91 %) and cough (69 %) were the most common symptoms. Upper respiratory infection was the principal clinical diagnosis (84.5 %), and 17 of the 72 samples (23.2 %) were positive. Most common viruses were RSV (41.1 %) and rhinovirus (35.2 %). Of the children visited, 17 out of 106 (16 %) (5.3 % of the cohort) were admitted to hospital. Diagnoses were febrile syndrome and bronchiolitis. We did not find any epidemiological factor associated with viral respiratory infection in positive cases. Conclusions: In our population most of the respiratory infections in infants are minor and do not need hospital assistance. Rhinovirus and RSV are the major pathogens. We did not find any epidemiological factor associated with viral respiratory infection (AU)

[Is the incidence of parapneumonic pleural effusion increasing?]. / Está aumentando la incidencia de derrames pleurales paraneumónicos?

INTRODUCTION: Streptococcus pneumoniae is the microorganism most frequently associated with complicated pleural effusion. After the introduction of the heptavalent pneumococcal vaccine, there was a decline in the incidence of invasive pneumococcal disease and, to a lesser extent, in that of pneumonia. However, the incidence of empyema apparently increased. The antipneumococcal heptavalent vaccine was introduced in Spain in 2001. OBJECTIVES: To determine whether the incidence of pleural effusion secondary to pneumonia has increased in hospitalized patients and to examine the possible influence of the antipneumococcal heptavalent vaccine on the incidence rate of parapneumonic effusions. PATIENTS AND METHODS: Patients aged less than 16 years old admitted to our hospital with a diagnosis of pneumonia between 1999 and 2005 were retrospectively reviewed. We calculated the annual incidence rate of pleural effusion with respect to the total number of patients admitted with pneumonia and with respect to patients considered to have probable bacterial pneumonia, based on previously established criteria. RESULTS: A total of 337 patients were analyzed, of which 213 (63.2%) met the criteria for a diagnosis of probable bacterial pneumonia. Pleural effusion was found in 34 patients (15.9%), and 13 of these effusions (38%) were complicated. No clear trend was detected in the annual incidence of probable bacterial pneumonia per 100 admitted patients, although the highest numbers were detected in the last two years of the study period. The percentage of complications (effusions) remained constant (mean: 16.28%). No differences were found in the effusion rate between vaccinated and unvaccinated patients (12.5% vs 18.6%). CONCLUSIONS: The trend in the incidence of parapneumonic pleural effusions was parallel and proportional to that of probable bacterial pneumonia.

¿Está aumentando la incidencia de derrames pleurales paraneumónicos? / Is the incidence of parapneumonic pleural effusion increasing?

Introducción: Streptococcus pneumoniae es el agente etiológico aislado con más frecuencia en los derrames paraneumónicos complicados. Desde la introducción de la vacuna antineumocócica heptavalente (VCN-7), ha disminuido la enfermedad neumocócica invasiva y, en menor grado, la incidencia de neumonías, pero con un aparente aumento del empiema. En España la vacuna fue comercializada en 2001. Objetivos: Determinar si existe un aumento de la incidencia de derrames pleurales en los pacientes ingresados por neumonía y la posible influencia de la vacunación con VCN-7 sobre la incidencia de dichos derrames. Pacientes y métodos: Estudio retrospectivo de los pacientes menores de 16 años ingresados en nuestro hospital por neumonía entre 1999 y 2005. Se calculó la incidencia anual de derrames pleurales respecto al número total de neumonías ingresadas y respecto a las consideradas como de probable origen bacteriano (NPOB) según criterios establecidos. Resultados: Se analizaron 337 pacientes. De éstos, 213 cumplían criterios de NPOB (63,2 %). Un total de 34 pacientes presentaron derrame pleural (15,9 %), 13 de los cuales (38 %) fueron complicados. No se pudo objetivar en el período estudiado una tendencia clara en la incidencia anual de NPOB por 100 pacientes ingresados, aunque en los dos últimos años se detectaron las cifras más altas. La proporción de complicaciones (derrames) se mantuvo constante (media 16,28 %). No existieron diferencias en la aparición de derrames entre los pacientes vacunados con VCN-7 y los no vacunados (12,5 % frente a 18,6 %). Conclusiones: Se objetiva una evolución de la incidencia de derrames pleurales paraneumónicos paralela y proporcional a la de las neumonías bacterianas (AU)

Introduction: Streptococcus pneumoniae is the microorganism most frequently associated with complicated pleural effusion. After the introduction of the heptavalent pneumococcal vaccine, there was a decline in the incidence of invasive pneumococcal disease and, to a lesser extent, in that of pneumonia. However, the incidence of empyema apparently increased. The antipneumococcal heptavalent vaccine was introduced in Spain in 2001. Objectives: To determine whether the incidence of pleural effusion secondary to pneumonia has increased in hospitalized patients and to examine the possible influence of the antipneumococcal heptavalent vaccine on the incidence rate of parapneumonic effusions. Patients and methods: Patients aged less than 16 years old admitted to our hospital with a diagnosis of pneumonia between 1999 and 2005 were retrospectively reviewed. We calculated the annual incidence rate of pleural effusion with respect to the total number of patients admitted with pneumonia and with respect to patients considered to have probable bacterial pneumonia, based on previously established criteria. Results: A total of 337 patients were analyzed, of which 213 (63.2 %) met the criteria for a diagnosis of probable bacterial pneumonia. Pleural effusion was found in 34 patients (15.9 %), and 13 of these effusions (38 %) were complicated. No clear trend was detected in the annual incidence of probable bacterial pneumonia per 100 admitted patients, although the highest numbers were detected in the last two years of the study period. The percentage of complications (effusions) remained constant (mean: 16.28 %). No differences were found in the effusion rate between vaccinated and unvaccinated patients (12.5 % vs 18.6 %). Conclusions: The trend in the incidence of parapneumonic pleural effusions was parallel and proportional to that of probable bacterial pneumonia (AU)

[Viral respiratory tract infections in the first six months of life]. / Infecciones virales de vías respiratorias en los primeros seis meses de vida.

BACKGROUND: Respiratory syncytial virus and Influenza virus infections are known causes of hospital admission in infants. It is less well known the pattern of virus infections in infants under 6 months of age in the outpatient setting. OBJECTIVE: To describe the clinical and epidemiological pattern of community-acquired viral respiratory infections in infants under 6 months. PATIENTS AND METHODS: A cohort of infants from the 8 and 9 Madrid Health Districts was followed by telephone calls every two weeks since birth during the epidemic winter season. Clinical and epidemiological data were collected in pre-designed questionnaires. Nasopharyngeal aspirate was obtained in every patient with symptoms compatible with respiratory infection. Diagnosis of the more common virus was made with direct immunofluorescence and nucleic acid amplification test (PCR). RESULTS: Were recruited 316 newborns. The 1,865 phone calls made (median 4 for every child), produced 106 visits, and the illness confirmed in 89 illness. Rhinitis (91%) and cough (69%) were the most common symptoms. Upper respiratory infection was the principal clinical diagnosis (84.5%), and 17 of the 72 samples (23.2%) were positive. Most common viruses were RSV (41.1%) and rhinovirus (35.2%). Of the children visited, 17 out of 106 (16%) (5.3% of the cohort) were admitted to hospital. Diagnoses were febrile syndrome and bronchiolitis. We did not find any epidemiological factor associated with viral respiratory infection in positive cases. CONCLUSIONS: In our population most of the respiratory infections in infants are minor and do not need hospital assistance. Rhinovirus and RSV are the major pathogens. We did not find any epidemiological factor associated with viral respiratory infection.

Tratamiento de la crisis asmática / No disponible

El tratamiento de la crisis asmática en pediatría debe ser precedido de una breve historia clínica y descansa principalmente en el uso de oxígeno, los fármacos beta-adrenérgicos de acción corta y los corticoides sistémicos. Las crisis leves y moderadas pueden ser tratadas en el centro de salud, que debe contar con oxígeno y con un pulsioxímetro. Se deben modificar las dosis de los fármacos y los tiempos de administración en relación con la gravedad de la crisis y la respuesta al tratamiento. En las crisis graves la adición de múltiples dosis del anticolinérgico bromuro de ipratropio inhalado aporta alguna ventaja a los beta-adrenérgicos solos. La vía ideal para ambos es la inhalada, tanto en nebulización como con inhalador presurizado y cámara espaciadora, y es preciso asegurarse del uso correcto de este último dispositivo. Los corticoides ejercen una excelente acción antiinflamatoria modulando la síntesis, la liberación y la actividad de los mediadores de la inflamación, y han mostrado su eficacia cuando se utilizan precozmente y por vía sistémica, si bien su efecto no es inmediato y nunca serán el primero ni el único fármaco a utilizar. En la actualidad no se recomienda la administración inhalada de los corticoides para el tratamiento de las crisis asmáticas. En el caso de una crisis asmática grave, existen otras medidas farmacológicas como la teofilina, cada vez menos utilizada, el sulfato de magnesio, y otras medidas más propias de las Unidades de Cuidados Intensivos Pediátricos

Before starting treatment for paediatric acute asthma a brief patient data must be obtained about previous asthma history. Treatment should include the use of oxygen, shortacting beta-adrenergic drugs, and systemic steroids. Mild and moderate asthma attacks can be treated at the Primary Care Paediatric Office, where oxygen source and a pulsyoxymeter device should be available. Drug dosage and administration schedules must be modified in relation with the exacerbation severity and patient response to therapy. In severe acute asthma, addition multiple inhaled ipratropium doses may bring some benefits to the betaadrenergic drugs alone. The best way for both beta-adrenergic and ipratropium is inhaled way, nebulization or inhalation with an inhalator and spacer, and it is necessary to be sure that child use the spacer properly. Steroids have an excellent anti-inflammatory action, by modulating the synthesis, liberation and activity of inflammation mediators, and its effectiveness has been shown when used early and in a systemic pattern. The clinical effect of steroids is not immediate, therefore must not be the first nor the only drug used. Currently, inhaled administration of steroids in the treatment of acute asthma exacerbation is not recommended. In case of severe asthma exacerbation, there are other therapeutic options as theophylline, magnesium sulphate, and other Intensive Care Unit measures if necessary

El electrocardiograma en Pediatría de Atención Primaria (I). Aspectos generales, indicaciones e interpretación sistemática / The electrocardiogram in Primary Care Pediatrics (I). General aspects, indications and systematic interpretation

Los electrocardiogramas (ECG) sigue siendo el método de elección para el diagnóstico no invasivo de las arritmias, siendo una prueba fácil de realizar, rápida, barata y uno de los pocos métodos diaggnósticos inmediatos con los que cuenta el pediatra de AP. Cuando se interpreta un electrocardiograma de un niño se deben considerar las variaciones normales que aparecen con el desarrollo, debidas a los cambios fisiológicos del aparato circulatorio, y tener a mano una tabla de valores normales. La intención de este artículo es repasar los conceptos generales de la interpretación de ECG en pediatría, mostrar un método sistemático de lectura del mismo y proporcionar tablas de valores de referencia. El pediatra de Atención Primaria no necesita tenergrandes conocimientos de electrofisiología sino, en la mayoría de los casos, saber si un ECG es normal o no

Electrocardiography is the method of choice for non-invasive diagnosis of arrhythmia being a procedure easy to perform, fast, not expensive and a procedure often available for the primary care paediatrician. Interpretation requires considering the normal changes with age brought about by the physiological variations that occur in the circulation system. In order to interpret paediatric electrocardiograms, the age of the patient and a table of normal values are essential. This article outlines general concepts of paediatric ECGs, shows a systematic approach for interpretation and includes tables of normal values. Primary care paediatricians do not needs a vast knowledge on electrophysiology but to distinguish between a normal and a pathological ECG

[Precocious puberty and pituitary incidentaloma]. / Pubertad precoz e incidentaloma hipofisario.

The case of an 9-year-old girl with precocious puberty and a non-functioning pituitary adenoma is described. A review of the literature on the incidence, evolution and therapeutic options of pituitary incidentalomas in children and adults is performed.

Pubertad precoz e incidentaloma hipofisario / Precocious puberty and pituitary incidentaloma

Se describe el caso de una niña de 9 años con pubertad precoz y el hallazgo casual de un adenoma hipofisario no funcional, así como su evolución a lo largo de 2 años y medio de seguimiento. También se realiza una revisión bibliográfica de la prevalencia de "incidentalomas" hipofisarios en la infancia y en la edad adulta, su evolución y las opciones terapéuticas (AU)

[Triple-therapy treatment during 1 month versus 2 weeks in gastroduodenal disease due to Helicobacter pylori in children]. / Tratamiento con triple terapia durante un mes versus dos semanas en la enfermedad gastroduodenal por Helicobacter pylori en el niño.

The aim of this study was to assess the clinical outcome of two different durations of triple therapy in children with Helicobacter pylori infection. We established two treatment groups: 1) Short treatment, including 2 week of bismuth subcitrate, amoxycillin and metronidazole treatment (n = 21) and 2) Long treatment, which included the same therapy for two weeks plus bismuth subcitrate alone for two weeks more (n = 26). We found no difference between the short and long treatments. The infection remained in 14% and 19%, respectively. In both groups, we observed children (19%) with persistent abdominal pain in spite of Helicobacter pylori eradication and gastritis healing. We conclude that it is not necessary to prolong triple therapy more than 2 weeks in order to have therapeutic success.