Screening de cardiopatías en niños y adolescentes (Prevencar Program) / Screening for heart disease in kids and adolescents (Prevencar Program)

Objetivo: El objetivo fue desarrollar un cribado de detección de cardiopatías en atención primaria, para identificar alteraciones electrocardiográficas patológicas y cardiopatías subyacentes en adolescentes. Diseño: Durante un año se realizó el estudio mediante muestreo polietápico. Lugar: Se seleccionaron los centros asistenciales de atención primaria en un área de salud, que dispusieran de equipo de electrocardiograma (ECG) digital (12 centros). Participantes: Inicialmente, se reclutó a 718 (16,6%) adolescentes de 14 años y se excluyeron a los que tenían un diagnóstico de cardiopatía previo. Intervención: El cribado consistió en incluir en la revisión obligatoria de los 14 años un cuestionario de salud y un ECG. Principales medidas: Para el cribado se realizó cuestionario, auscultación cardíaca, ECG y ecocardiografía. Se establecieron criterios de anormalidad para remitir a una segunda valoración por un cardiólogo. Resultados: Finalmente la muestra la componen 698 adolescentes, con una edad media de 13,7± 0,5 años, de los cuales 354 (50,7%) fueron chicos. Fueron seleccionados 149 (21,3%) para la segunda revisión por cardiología: 88 (12,6%) por cuestionario positivo, 11 (2,2%) por auscultación cardíaca anormal y 66 (9,5%) por hallazgos en ECG. Los adolescentes con evidencia de cardiopatía fueron 24 (3,4%). De ellos, 14 (2,0%) tuvieron alteraciones sugestivas y se les recomendó seguimiento, 6 (0,9%) tuvieron diagnóstico definitivo de cardiopatía y 4 (0,6%) tenían otros hallazgos patológicos relacionados con el sistema cardiovascular. Conclusiones: El cribado permitió identificar un 1% de adolescentes con cardiopatía y otro 2% permanecerá en seguimiento. El ECG detectó más casos patológicos que el cuestionario.(AU)

Objective: The objective was to develop a screening for heart disease detection in primary care, to identify pathological electrocardiographic changes and underlying heart disease in adolescents. Design: The study was carried out for one year using multistage sampling. Site: Primary care centers in a health area that had digital ECG equipment (12 centers) were selected. Participants: Initially, 718 (16.6%) 14-year-old adolescents were recruited and those with a previous diagnosis of heart disease were excluded. Interventions: Screening consisted of including a health questionnaire in the mandatory 14-year-old check-up. Main measurements: Screening included a questionnaire, cardiac auscultation, ECG and echocardiography. Abnormality criteria were established to refer for a second evaluation by a cardiologist. Results: Finally, the sample was made up of 698 adolescents, with a mean age of 13.7±0.5 years, and 354 (50.7%) were boys. A total of 149 (21.3%) were selected for a second review by cardiology: 88 (12.6%) due to a positive questionnaire, 11 (2.2%) due to abnormal cardiac auscultation, and 66 (9.5%) due to ECG findings. Adolescents with evidence of heart disease were 24 (3.4%). Of these, 14 (2.0%) had suggestive alterations and follow-up was recommended, 6 (0.9%) had a definitive diagnosis of heart disease, and 4 (0.6%) had other pathological findings related to the cardiovascular system. Conclusions: The screening allowed us to identify 1% of adolescents with heart disease and another 2% will remain in follow-up. The ECG detected more pathological cases than the questionnaire.(AU)

[Screening for heart disease in kids and adolescents (Prevencar Program)]. / Screening de cardiopatías en niños y adolescentes (Prevencar Program).

OBJECTIVE: The objective was to develop a screening for heart disease detection in primary care, to identify pathological electrocardiographic changes and underlying heart disease in adolescents. DESIGN: The study was carried out for one year using multistage sampling. SITE: Primary care centers in a health area that had digital ECG equipment (12 centers) were selected. PARTICIPANTS: Initially, 718 (16.6%) 14-year-old adolescents were recruited and those with a previous diagnosis of heart disease were excluded. INTERVENTIONS: Screening consisted of including a health questionnaire in the mandatory 14-year-old check-up. MAIN MEASUREMENTS: Screening included a questionnaire, cardiac auscultation, ECG and echocardiography. Abnormality criteria were established to refer for a second evaluation by a cardiologist. RESULTS: Finally, the sample was made up of 698 adolescents, with a mean age of 13.7±0.5 years, and 354 (50.7%) were boys. A total of 149 (21.3%) were selected for a second review by cardiology: 88 (12.6%) due to a positive questionnaire, 11 (2.2%) due to abnormal cardiac auscultation, and 66 (9.5%) due to ECG findings. Adolescents with evidence of heart disease were 24 (3.4%). Of these, 14 (2.0%) had suggestive alterations and follow-up was recommended, 6 (0.9%) had a definitive diagnosis of heart disease, and 4 (0.6%) had other pathological findings related to the cardiovascular system. CONCLUSIONS: The screening allowed us to identify 1% of adolescents with heart disease and another 2% will remain in follow-up. The ECG detected more pathological cases than the questionnaire.

Evaluación mediante script concordance test del razonamiento clínico de residentes en Atención Primaria / Clinical reasoning evaluation using script concordance test in primary care residents

Introducción: Actualmente desconocemos el razonamiento clínico objetivo de los residentes durante su formación, lo que impide orientar su reciclaje formativo a solventar los déficits detectados. El script concordance test (SCT) evalúa el razonamiento clínico planteando situaciones clínicas reales, pero aún no ha sido utilizado en España con contenidos propios de Atención Primaria. Por ello consideramos relevante diseñar un SCT de Atención Primaria que cumpla los criterios de validez, fiabilidad y aceptabilidad descritos en la bibliografía. Métodos: Elaboración, corrección y validación de un SCT para evaluar el razonamiento clínico en Atención Primaria de los residentes y que incluya variables sociolaborales para estudiar su posible relación con la puntuación obtenida. Resultados: Nuestro cuestionario fue aprobado por un comité de expertos, alcanzó una fiabilidad y accesibilidad adecuadas, y distinguió a los expertos de los residentes. No se observaron diferencias estadísticamente significativas en función de la edad, género, tipo y duración de la formación recibida en Atención Primaria, y la realización de un curso sobre dicha formación. Conclusiones: Se construyó un SCT que obtuvo la aprobación por parte de un comité de expertos, cumplió con los criterios de fiabilidad y accesibilidad, y permitió objetivar diferencias significativas en el razonamiento clínico de los expertos y residentes. Excepto en el 2.o año de residencia, no se observaron diferencias estadísticamente significativas respecto al año formativo dentro de la residencia, la edad, el género, la realización y duración de la rotación en Atención Primaria y la realización de un curso sobre dicha formación. (AU)

Introduction: Actual unawareness about paediatric resident's residency program factual clinical reasoning precludes professional retraining directed to solve deficiencies. Script concordance test (SCT) evaluates clinical reasoning due to its orientation to usual clinical practice but surprisingly it has not been used in Spain for Paediatric Primary Care clinical reasoning evaluation so far. Due to this we consider to be of relevance to design a paediatric primary care SCT which meets validity, reliability and accessibility criteria described in bibliography.Methods: Development, validation and application of an SCT questionnaire for clinical reasoning analysis in paediatric primary care applied on a population of paediatric residents and which includes demographic and employment data in order to study possible relationship between them and achieved scores.Results: Our SCT was approved by an experts committee. It met reliability and accessibility criteria and it allowed distinguishing experts from paediatric internal residents. No statistically significant differences were found concerning age, gender, type and duration of the training received in Primary Care, and the completion of a course on that training.Conclusions: We developed an SCT that was approved by a Paediatric Experts Committee, it met reliability and accessibility criteria and it allowed distinguishing clinical reasoning from experts and paediatric internal residents. Except second year residency program, we did not objectified relevant differences in residency program year, age, gender, duration and realization of Paediatric Primary Care rotation, and training course realisation. (AU)

Clinical reasoning evaluation using script concordance test in primary care residents.

INTRODUCTION: Actual unawareness about paediatric resident's residency program factual clinical reasoning precludes professional retraining directed to solve deficiencies. Script Concordance Test (SCT) evaluates clinical reasoning due to its orientation to usual clinical practice but surprisingly it has not been used in Spain for Paediatric Primary Care clinical reasoning evaluation so far. Due to this we consider it to be of relevance to design a Paediatric Primary Care SCT which meets validity, reliability and accessibility criteria described on bibliography. METHODS: Development, validation and application of an SCT questionnaire for clinical reasoning analysis in Paediatric Primary Care applied on a population of paediatric residents and which includes demographic and employment data in order to study possible relationship between them and achieved scores. RESULTS: Our SCT was approved by an experts committee. It met reliability and accessibility criteria and it allowed distinguishing experts from paediatric internal residents. No statistically significant differences were found concerning age, gender, type and duration of the training received in Primary Care, and the completion of a course on that training. CONCLUSIONS: We developed a SCT that was approved by a Paediatric experts committee, it met reliability and accessibility criteria and it allowed distinguishing clinical reasoning from experts and paediatric internal residents. Except second year residency program, we didn't objectified relevant differences in residency program year, age, gender, duration and realization of Paediatric Primary Care rotation, and training course realization.

Déficit de factor XI. A propósito de un caso / Acquired factor XI deficiency. A case reports

La deficiencia de factor XI es un trastorno hereditario de la coagulación en el que existe una reducción cuantitativa o cualitativa del factor XI debido a mutaciones en el gen F11. Es una entidad común entre los asquenazíes, que puede ser subestimada en los caucásicos. Puede debutar a cualquier edad con clínica variable e impredecible, existiendo escasa relación entre los niveles de actividad del factor XI y los síntomas hemorrágicos. Su diagnóstico se basa en la realización de un estudio de coagulación básico (alargamiento del tiempo parcial de tromboplastina activado [TTPA]) y la medición de los niveles del factor XI. Presentamos un caso con el objetivo de difundir esta entidad entre la comunidad pediátrica

Factor XI deficiency is a hereditary coagulation disorder with a quantitative and/or qualitative reduction of factor XI due to F11 gene mutations. This is a common entity in Ashkenazi community, which can be underestimated in Caucasians. It can debut at any age with variable and unpredictable symptoms, showing poor relation between factor XI activity levels and bleeding symptoms. It can be diagnosed after a basic coagulation exam (lengthening activated partial thromboplastin time [APTT]) and factor XI levels measure. We present a factor XI deficiency clinical case for spreading this entity to the pediatric community

Pitiriasis liquenoide: no todo es varicela. A propósito de un caso / Pityriasis lichenoides. Not everything is chickenpox. A case report

La pitiriasis liquenoide es una entidad inflamatoria benigna de etiología aún desconocida. Existen dos subtipos dentro de esta entidad, la forma aguda (pitiriasis liquenoide varioliforme aguda) y la forma crónica (pitiriasis liquenoide crónica). Ambas son comunes en niños y adultos jóvenes. Describimos un caso de pitiriasis liquenoide aguda y discutimos su presentación clínica, diagnóstico y tratamiento: un escolar de 8 años que presenta un brote agudo de exantema papular pruriginoso con lesiones de distribución centrípeta, las cuales no variaron durante 3 semanas, aparecieron nuevas lesiones durante dicho periodo. La biopsia de las lesiones confirmó el diagnóstico de pitiriasis liquenoide. Tras completar el tratamiento con macrólidos y corticoide tópico se produjo remisión de las lesiones. La pitiriasis liquenoide aguda es una entidad poco frecuente que supone un reto diagnóstico para el pediatra. Su diagnóstico se basa en la sospecha clínica y la confirmación histopatológica. No tiene un tratamiento específico

Pityriasis lichenoides is a benign inflammatory disease of unknown etiology. There are two types of this entity: an acute form (pityriasis lichenoides et varioliformis acuta) and a chronic one (pityriasis lichenoides chronica). Both are common in children and young adults. We describe a case of pityriasis lichenoides, discuss its clinical presentation, diagnosis and treatment. An eight-year-old child who presented erythematous papular lesions in centripetal distribution, these lesions didn't improve in 3 weeks, and new lesions appeared in that period. The biopsy of the lesions confirmed pityriasis lichenoid. After antibiotic and corticosteroid treatment all lesions disappeared. Pityriasis lichenoides acute is a rare design that represents a diagnostic and therapeutic challenge to the physician. The diagnosis of this condition is suspected clinically and confirmed by histology. It does not have specific treatment

Síncope por peinado del cabello / Hair-combing syncope

El síncope es una entidad clínica frecuente en Pediatría, sobre todo en la adolescencia. La etiología más frecuente la constituyen los síncopes neurocardiogénicos o vasovagales, de naturaleza benigna y causados por múltiples desencadenantes. Un grupo específico son los síncopes situacionales caracterizados por tener lugar en el contexto de una situación concreta, entre las cuales se encuentra el cuidado del cabello. El diagnóstico se basa principalmente en la historia clínica y la exploración física. Presentamos el caso clínico de una niña de 11 años que presenta un episodio de pérdida de conciencia breve y transitoria mientas le peinaban el pelo. Recuperación completa posterior y exploración normal. Nuestra labor como pediatras es saber reconocer esta entidad para llevar a cabo un tratamiento correcto basado en la educación e información al paciente y a la familia, con el fin de tranquilizarlos y evitar la realización de pruebas y derivaciones innecesarias

Syncope is a frequent clinical entity in Pediatrics, especially in adolescence. Vasovagal syncope is the most frequent type, of benign nature and caused by several triggers. Situational syncope is a special type which happen on concrete situations like hair care. Diagnosis is based on clinical history and physical exploration. We report the case of an 11 years old girl who suffered a brief loss of consciousness while her hair was combed, with later total recovery and normal physical exploration. Pediatricians must recognize this entity to make a correct treatment and inform patient and family, in order to reassure them and avoid unnecessary tests

Breastfeeding Duration and Anogenital Distance in 2-Year-Old Infants.

BACKGROUND: The anogenital distance (AGD) is an anthropometric marker determined by exposures to androgens in utero and throughout the first few months of life. Early exposures to endocrine-disrupting chemicals such as phthalates have been significantly associated with shortened AGD in boys. Limited studies have explored phthalate concentrations in breast milk and infant formula. OBJECTIVE: To explore the associations between breastfeeding duration and AGD measures in infants. MATERIALS AND METHODS: MALAMA (Medio Ambiente y Lactancia Materna) is a follow-up study of 430 mother-child pairs, from birth to 2 years, from two population-based cohorts in Murcia, Spain. Data were collected through medical visits and telephone surveys from birth to 2 years of age. World Health Organization breastfeeding definitions were used. AGD measurements were assessed in a subsample of 71 boys and 49 girls at the 2-year visit. Descriptive analyses, Pearson correlations, and linear regressions were calculated between AGD and breastfeeding duration. RESULTS: Duration of all types of breastfeeding, especially full breastfeeding (FB), is correlated with AGD measures in boys (p < 0.05). AGDAS (anoscrotal distance) and AGDAP (anopenile distance) were positively associated with FB (ß = 0.004, 95%CI: 0.001-0.007 and ß = 0.003, 95%CI: 0.000-0.007, respectively). CONCLUSIONS: A positive correlation between AGD in male infants and the duration of breastfeeding is reported. Inversely, early introduction of infant formula could lead to the reduction of AGD in boys.