Tumefacción clavicular, ¿de causa traumática? / Clavicular swelling: Is it due to trauma?

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Absceso retroorbitario por «Streptococcus constellatus» en un paciente con neurocisticercosis / Retro orbital abscess by "Streptococcus constellatus" in a patient with neurocysticercosis

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Hemorragia digestiva alta: Helicobacter pylori e ingesta de ácido acetil salicílico / Upper gastrointetinal bleeding. Helicobacter pylori and intake of acetylsalicylic acid

Introducción. La hemorragia digestiva en niños requiere un adecuado diagnóstico etiológico, que variará en función de la localización, edad del paciente. Ante la presencia de hemorragia digestiva alta, se debe considerar la infección por Helicobacter pylori, ya que se asocia a gastritis crónica y desarrollo de úlcera garoduodenal. Además se deberán tener encuentra otros factores como realización de pruebas invasivas, ingesta de cuerpo extraño o tratamiento con antinflamatorios no esteroideos. Caso clínico. Describimos el caso de un niño de 11 años, que presenta una hemorragia digestiva alta asociada a enfermedad ulceropéptica por helicobacter pylori exacerbada por la ingesta de ácido acetil salicílico. Conclusiones. La infección por Helicobacter pylori puede permanecer asintomática hasta la edad adulta y aunque la primera manifestación suele ser el dolor abdominal, no deberemos olvidarla ante la presencia de hemorragia digestiva, patología poco habitual en la edad pediátrica, peor que se correlaciona con este microrganismo de manera similar a la población adulta. Se deberá descartar la presencia de otros factores de riesgo como la ingesta de ácido acetil salicílico u otros antinflamatorios no esteroideos, que pueden provocar exacerbaciones en una mucosa dañada previamente (AU)

Introduction. Gastrointestinal hemorrhage in children requires an adequate etiologic diagnosis, which depends on the location and the age of the patient. In upper gastrointestinal bleeding, Helicobacter pylori infection should be considered, because it is associated with chronic gastritis an peptic ulcer. In addition other factors such invasive techniques, foreign body ingestion or AINES therapy should be investigated. Clinical case. We report the case of a child under 11 years, who presents an upper gastrointestinal bleeding, associated with Helicobacter pylori peptic ulcer disease which was exacerbated by aspirin ingestion. Conclusions. Helicobacter pylori infection can remain asymptomatic until adulthood, and although the first manifestation is usually abdominal pain, we shouldn´t forget it in the presence of gastro intestinal bleeding, unusual disease in children, but with similar correlation that in the adult people. We should investigate other risk factors such as the ingestion of aspirin or other AINES, which cause exacerbation in a previously damaged mucosa (AU)

Síndrome de Gilbert: estudio de 12 observaciones y revisión de la bibliografía médica / Gilbert’s syndrome: a study of 12 observations and review of the literature

El síndrome de Gilbert es el hallazgo de hiperbilirrubinemia indirecta leve-moderada con pruebas de función hepática normales y sin signos de hemólisis. Es un trastorno hereditario del metabolismo de la bilirrubina, benigno, con una prevalencia mundial cercana al 10%. Tiene un patrón de herencia variable, con polimorfismo genético. Se diagnostica mediante pruebas confirmatorias de provocación, como la prueba del ayuno, aunque el diagnóstico definitivo es genético. Su pronóstico es bueno y actualmente se discute sobre los diversos efectos de la hiperbilirrubinemia. En este artículo, se revisan los casos diagnosticados de síndrome de Gilbert en el servicio de pediatría de un hospital universitario en los últimos años, y se describen las principales características halladas

Gilbert’s syndrome is characterized by a mild or moderate elevation of unconjugated bilirubin, with normal liver function and no evidence of hemolysis. It is a benign inherited disorder of bilirubin metabolism, with a worldwide prevalence of nearly 10%. It has a variable pattern of inheritance, with genetic polymorphism. Diagnosis is based on a confirmatory provocation test, such as the fasting test, although the definitive diagnosis requires a genetic study. The prognosis is good and, at the present time, the varied effects of hyperbilirubinemia are a matter of debate. The cases of Gilbert’s syndrome diagnosed in the pediatric service of a university hospital in recent years were reviewed and the main characteristics are described

El niño inmigrante: compendio de parasitología / The immigrant child: a compendium of parasitology

El incremento de los viajes y las migraciones internacionales ha supuesto un aumento de la incidencia de patologías poco habituales en nuestro medio, en las que hay que pensar ante un paciente con estas características. Los parásitos son responsables de muchas de estas enfermedades, por tanto, deberá descartarse su presencia en estos niños, a pesar de que la expresividad clínica no sea florida, para poder hacer un tratamiento adecuado. En el caso de la poliparasitosis, es conveniente ser prudente con el tratamiento, ya que la erradicación masiva puede inducir una respuesta inmunitaria desmesurada. Presentamos el caso de una niña, a pesar de su buen estado general, fue diagnosticada de una parasitosis múltiple

The increase migration and international travels has resulted in a rise in the incidence of diseases that are uncommon in out environment, andthat should be taken into consideration in the case of a patient with these characteristics. As parasites are responsible for many of these diseases, we have to check for their presence, even when clinical manifestation are mid, in order to choose the proper treatment, In the case of polyparasitism, a cautious approach to treatment is recommended since the massive eradication of the parasites can induce an excessive immune response. We report the case of a girl who, despite her apparent good general health, was diagnosed as having multiple parasitic infections

"Hymenolepis nana", un parásito a tener en cuenta en nuestro medio / "Hymenolepis nana", a parasite to be taken into consideration in our patient population

Los autores estudian retrospectivamente las características epidemiológicas y clínicas de 13 pacientes parasitados por Hymenolepis nana, e inciden especialmente en la importancia de la higiene en la transmisión de la enfermedad y en el incremento de casos identificados en niños adoptados e inmigrantes. También hacen hincapié en manifestaciones clínicas menos habituales, como la enfermedad neurológica que presentan dos de los pacientes. El tratamiento se realizó en todos los casos con praziquantel, y se tomaron las medidas oportunas para eliminar las fuentes de infección y prevenir la transmisión de la enfermedad, cuyo mecanismo más habitual es persona a persona (AU)

Tuberculosis ganglionar producida por "Mycobacterium bovis", transmitida por herida de asta de vaca / Lymph node tuberculosis produced by "Mycobacterium bovis" transmitted through a wound caused by a cow horn

Introducción: La infección producida por Mycobacterium bovis es una forma excepcional de tuberculosis humana en los países desarrollados. En la actualidad, se consideran como agentes etiológicos de la tuberculosis humana M. tuberculosis, M. bovis, M. africanum y el bacilo de Calmette-Guerin. Caso clínico: Niño de 14 años contagiado de tuberculosis a través de la herida producida por el asta de una vaca brava y que afecta a los ganglios próximos a dicha herida. Discusión: En la mayoría de los países con condiciones sanitarias avanzadas, la tuberculosis humana producida por M. bovis es escasa o casi inexistente, gracias al control de los animales y a la pasteurización de la leche de vaca. M. bovis es una de las especies del complejo M. tuberculosis y es el agente causal de la tuberculosis bovina, aunque cuenta con gran cantidad de especies hospedadoras diferentes, entre ellas, la humana, sin olvidar el ganado bovino infectado, ganado porcino, tejones y otros mamíferos (AU)

Síndrome hemofagocítico reactivo a infección por "Salmonella typhi" / Reactive hemophagocytic síndrome caused by "salmonella typhi" infection

El síndrome hemafagocítico (SHF) o histiocitosis reactiva es un trastorno de la inmunorregulación en el que, de forma primaria o secundaria, se desencadena una activación y proliferación incontrolada, no maligna de linfocitos T y macrófagos, con intensa actividad fagocítica de células hematopoyéticas. Se asocia a un estado de hipercitocinemia responsable de la mayoría de los síntomas y su diagnóstico incluye un conjunto de datos clínicos, de laboratorio y hallazgos histológicos, con hemofagocitosis prominente. Se presenta el caso de un niño afectado por síndrome hemafagocítico reactivo (SHFR) a infección por Salmonella typhi (AU)

[Cytomegalovirus retinitis in a pediatric AIDS patient]. / Retinitis por citomegalovirus en una paciente pediátrica diagnosticada de SIDA.

INTRODUCTION: Cytomegalovirus retinitis (CMV) is the most frequently found opportunistic eye infection in adults with AIDS, with mean incidence of 20%-50%. However, only 5% of children with AIDS have this infection. CLINICAL CASE: We present the case of a six year old girl with stage C3 AIDS diagnosed at the age of 20 months, who developed unilateral diffuse retinitis due to CMV. The infection involved the posterior pole of the right eye, with retinal atrophy along the temporal vascular arcodes, and an active advance front in the temporal macula. The optic nerve was not found to be involved although the peripheral areas of the retina were involved leading to rhegmatogenous detachment of the superotemporal retina. In view of the systemic deterioration of the patient, no specific anti-CMV treatment was given. The patient died of respiratory insufficiency a few weeks later. CONCLUSIONS: CMV retinitis in paediatric AIDS patients is usually associated with more severe illness and a poorer general health than the adult population. In view of the absence of symptoms in these patients, periodic ophthalmoscopic examinations should be done in those who have severe immunological deterioration.

[Reduced erythrocyte glutathione and urinary thioethers in children undergoing treatment with paracetamol]. / Glutation reducido eritrocitario y tioeteres urinarios en niños tratados con paracetamol.

In the present study the objective was to evaluate whether therapeutic doses of paracetamol in children has an impact on the concentrations of erythrocyte reduced glutathione (GSH) and urinary thioethers (UT), used as indicators of internal exposure to electrophiles, as well as to establish the association between the two parameters. The population sample consisted of 40 children. From each patient, two blood and two urine samples were taken. Sample A was obtained one week after completing treatment and sample B was taken two hours after taking the last dose of paracetamol. The total group was divided into three subgroups according to age: subgroup I from 9 to 8 months, subgroup II from 19 to 72 months and subgroup III from 73 to 132 months. The concentrations of GSH and UT have been determined in blood and urine, respectively. The results demonstrate that after treatment with paracetamol for a period of days (3.57 +/- 0.86) an elevation in GSH was produced in the total group (Z = -2.40, p < 0.05). A significant and positive association (r = 0.52) existed between the GSH and UT values. No correlation was observed either between plasma levels, or the duration of treatment and the effects observed on GSH and UT.

Helicobacter pylori serology in patients with gastric carcinoma.

Helicobacter pylori-associated gastritis has been put forward as a distinct risk factor for gastric cancer. Furthermore, among H. pylori-positive individuals a correlation between a high serum level of H. pylori antibodies and the risk of gastric cancer has been found in two different studies. Other studies have challenged this hypothesis. We therefore studied the presence and level of H. pylori serum antibodies, using an enzyme-linked immunosorbent assay technique in 116 gastric cancer patients (65 men; mean age, 67 years; range, 23-92 years) and 116 controls matched for age and sex. Patients and controls were selected on referral for gastroscopy. The prevalence of infection in gastric cancer patients was 77% (89 of 116) and in controls 79% (92 of 116). This difference is not statistically significant, nor is the prevalence of infection in cases and controls of different age cohorts significantly different. High levels of serum antibodies were found in 46% (53 of 116) of gastric cancer patients and 40% (46 of 116) of controls. Comparison of the prevalence of high serum levels of antibodies for the total population and for the different age cohorts did not show significant differences either. We conclude that the comparison of actual H. pylori infection in a cross-sectional study of gastric cancer patients and controls does not enable relative risk calculation in the study of the role of H. pylori infection in gastric carcinogenesis. Prospective studies showing diminishment of the risk for gastric cancer after eradication of H. pylori are required.

[Salmonellosis in infancy and childhood: epidemiologic aspects]. / Salmonelosis en la infancia: aspectos epidemiológicos.

Diarrheic processes from an infectious origin constitute a frequent pathology during childhood. We have analyzed, from a epidemiological point of view, a series of 117 children diagnosed as having diarrhea and having stool cultures bacteriologically positive for Salmonella. Special reference has been made to the epidemiological chain of this infection. Of the patients studied, 68 (58.2%) were boys and 49 (41.8%) were girls. Their ages ranged between 1 month and 14 years. An epidemiological environment was recognized in 34.1% of the cases. The most frequent serotype was Salmonella Enteritidis (72.6%).

[Bacterial diarrhea in infancy: epidemiologic study of 256 cases]. / Diarrea bacteriana en la infancia: estudio epidemiológico de 256 casos.

Infectious diarrhoea are common causes of morbility in children. Although viral agents are responsible for the majority of cases of acute diarrhoea during infancy, bacterial infections are also well recognized as causes of them. 256 patients with diarrhoea due to a bacterial pathogen were studied to determine the importance of different epidemiologic factors. The study group comprised 151 boys (59%) and 105 girls (41%) aged between first month and 14 years. Family history of acute diarrhoea was found in 15% of children. 63,7% of them were hospitalized by the severity of clinical features. 32% of cases were detected in summer. Salmonella entérica was isolated in 45% of stool samples and Campylobacter spp in 33,2%. Clinical evolution of diarrhoea differentiated the patients into three groups: acute diarrhoea (95,7%), prolonged diarrhoea (3,1%) and chronic diarrhoea (1,1%).

[Cortical evoked auditory evoked potentials in a series of patients who had bacterial meningitis during childhood]. / Potenciales evocados auditivos corticales (PEAC) en una serie de pacientes que han padecido meningitis bacteriana en la edad pediátrica.

Cortical auditory evoked potentials (CAEP) were recorded from scalp electrodes in 47 patients, who survived to bacterial meningitis in their childhood. CAEP were obtained from 1 month to 8 years after recovering from acute disease. Neisseria meningitidis was the microorganism more frequently isolated from CSF (43.5%). Exclusively abnormal values in amplitude of CAEP were registered in 15 cases (32%), mainly at the lower tones explored; 14 of them were subjected to conventional audiometric test, which demonstrated unilateral hearing loss only in 2. No alterations in the latency of P2 wave were seen. We recommend to include CAEP in search of hearing disorders in younger children after recovering from meningitis, since they can detect lesions in cortical-subcortical auditory tracts, which otherwise could go unnoticed.