Epidemiología de las fiebres tifoidea y paratifoidea en España. A propósito de cuatro casos / Epidemiology of typhoid and paratyphoid fever in Spain. A study of four cases

Introducción: La fiebre entérica (término que incluye la fiebre tifoidea y paratifoidea) es una infección sistémica causada por Salmonella typhi y Salmonella paratyphi. En los países desarrollados, la fiebre entérica dejó de ser endémica para convertirse en una enfermedad frecuentemente asociada a los viajes a zonas endémicas. Pacientes y métodos: Revisión de los casos de fiebre entérica confirmados por hemocultivo, en el periodo comprendido entre el 1 de enero de 2009 y el 31 de diciembre de 2010. Resultados: Se recogieron cuatro casos: fiebre tifoidea en una niña de 12 años natural de Pakistán y en una niña de 13 años originaria de la India que residían en Barcelona y viajaron en vacaciones a su país de origen; fiebre paratifoidea en un niño inmigrante procedente de Senegal, y fiebre paratifoidea en un lactante asociada a una tortuga como vector de transmisión. En todos ellos la fiebre se presentó como síntoma y signo principal de la enfermedad. Todos respondieron bien al tratamiento con amoxicilina-ácido clavulánico. Ningún paciente presentó complicaciones graves. Discusión: Los niños inmigrantes que viajan a sus países de origen para visitar a amigos y familiares presentan un mayor riesgo de enfermar. Los reptiles, portadores habituales de diferentes serovariedades de Salmonella, pueden actuar como posibles vectores de transmisión(AU)

Introduction: Enteric fever (term including typhoid and paratyphoid fever) is a systemic infection caused by Salmonella typhi and Salmonella paratyphi. In developed countries, enteric fever is no longer an endemic disease and has become an infection frequently related to travel to endemic areas. Patients and methods: Review of cases of enteric fever confirmed by blood culture, during the period from January 1st2009 to December 31st 2010.Results: We present four cases: typhoid fever in a 12-yearold girl native of Pakistan and in a 13-year old girl from India, who both lived in Barcelona and traveled on vacation to their country of origin; paratyphoid fever in an immigrant child from Senegal and paratyphoid fever in an infant with a turtle as the vector of transmission. In all cases, fever was the main symptomand sign of the disease. All responded well to treatment with amoxicillin-clavulanate. None of the patients had serious complications. Discussion: Immigrant children who travel to their countries of origin to visit friends and/or relatives are at increased risk of disease. Reptiles, which are common carriers of different Salmonella serovars, may act as potential transmission vector(AU)

Seguridad y eficacia del polietilenglicol 3350 con electrolitos en el tratamiento del estreñimiento funcional en niños / Safety and efficacy of polyethylene glycol 3350 plus electrolytes for the treatment of functional constipation in children

Introducción: El objetivo del trabajo ha sido evaluar la seguridad del PEG 3350 con electrolitos (PEG+E) a nivel renal y digestivo. Objetivo secundario: valorar su eficacia y dosis de efectividad. Pacientes y métodos: Quince pacientes con estreñimiento funcional (criterios de Roma III) y función renal normal fueron evaluados. La mediana de edad fue de 6,2 años (r=2-9). Sobres pediátricos de PEG+E fueron administrados durante 4 semanas (4ST) La dosis media administrada fue de 0,44g/kg/día. La natruria y osmolaridad urinaria se midieron al inicio y a las 4ST. La determinación de principios inmediatos en heces mediante FENIR (análisis de reflexión de infrarrojos) y una prueba de hidrógeno espirado fueron efectuadas a las 4ST. La eficacia del tratamiento fue evaluada mediante el cambio en el número de deposiciones por semana y la consistencia de las heces (escala de Bristol). Resultados: A las 4ST el número de deposiciones por semana fue de 5,29±1,68 vs 2,46±0,71 al inicio (p<0,001). La puntuación de la escala de Bristol fue de 4,5±0,91 tras 4TS vs 2,47±1,24 al inicio (p<0,001). No se encontraron diferencias estadísticas entre los valores de sodio y osmolalidad en orina al inicio vs 4ST. Los valores de FENIR fueron normales en todos los pacientes. La prueba del aliento de hidrógeno fue normal con una mediana de 7ppm. Conclusiones: No se observaron efectos adversos renales ni alteraciones digestivas. El PEG+E puede ser recomendado para el tratamiento del estreñimiento funcional en los niños (AU)

Introduction: Polyethylene glycol 3350 plus electrolytes (PEG+E) efficacy has been validated in some studies, but not many have evaluated its safety in children. The aim of our study was to evaluate the safety; renal, malabsorption or excessive production of gas and efficacy of PEG+E treatment in our paediatric population. Patients and methods: Fifteen patients who suffered functional constipation (Rome III criteria) were evaluated. Median age was 6.2 years (r 2-9). All patients had normal renal function. PEG+E were administered for 4weeks (4WP). The mean dose was 0.44g/kg/day, titrated according to age, weight and response. Urine screens (sodium and osmolality) were performed at the beginning and 4WP. Stool sample NIRA (near-infrared reflectance analysis) and hydrogen breath test analysis samples were performed at 4WP. To analyse the efficacy of the treatment, the number of stools per week and stool form type (Bristol stool scale) were recorded. Results: The number of stools per week was higher after 4weeks (2.46±0.71 vs 5.29±1.68, P<0.001), as well as the stool form score (2.47±1.24 vs 4.5±0.91, P<0.001). No statistical differences were obtained between urine sodium and urine osmolality values at the beginning and 4WP. After 4WP the NIRA median values were normal in all patients [fat 4.45% (range (r) 3.6-7.09); nitrogen 0.78% (r 0.4-1); sugars 1.4% (r 0.47-2.35) and water 68% (r 59-74)]. Median breath hydrogen test was 7ppm (r 2-18). Conclusions: No adverse effects on biochemistry values or gastrointestinal disturbances were observed. PEG+E can be recommended for the treatment of functional constipation in children (AU)

[Safety and efficacy of polyethylene glycol 3350 plus electrolytes for the treatment of functional constipation in children]. / Seguridad y eficacia del polietilenglicol 3350 con electrolitos en el tratamiento del estreñimiento funcional en niños.

INTRODUCTION: Polyethylene glycol 3350 plus electrolytes (PEG+E) efficacy has been validated in some studies, but not many have evaluated its safety in children. The aim of our study was to evaluate the safety; renal, malabsorption or excessive production of gas and efficacy of PEG+E treatment in our paediatric population. PATIENTS AND METHODS: Fifteen patients who suffered functional constipation (Rome III criteria) were evaluated. Median age was 6.2 years (r 2-9). All patients had normal renal function. PEG+E were administered for 4 weeks (4WP). The mean dose was 0.44 g/kg/day, titrated according to age, weight and response. Urine screens (sodium and osmolality) were performed at the beginning and 4WP. Stool sample NIRA (near-infrared reflectance analysis) and hydrogen breath test analysis samples were performed at 4WP. To analyse the efficacy of the treatment, the number of stools per week and stool form type (Bristol stool scale) were recorded. RESULTS: The number of stools per week was higher after 4 weeks (2.46 ± 0.71 vs 5.29 ± 1.68, P<.001), as well as the stool form score (2.47 ± 1.24 vs 4.5 ± 0.91, P<.001). No statistical differences were obtained between urine sodium and urine osmolality values at the beginning and 4WP. After 4WP the NIRA median values were normal in all patients [fat 4.45% (range (r) 3.6-7.09); nitrogen 0.78% (r 0.4-1); sugars 1.4% (r 0.47-2.35) and water 68% (r 59-74)]. Median breath hydrogen test was 7 ppm (r 2-18). CONCLUSIONS: No adverse effects on biochemistry values or gastrointestinal disturbances were observed. PEG+E can be recommended for the treatment of functional constipation in children.

[Hepatomegaly due to glycogen storage disease and type 1 diabetes mellitus]. / Hepatomegalia por depósito de glucógeno hepático y diabetes mellitus tipo 1.

Patients with type 1 diabetes and poor metabolic control can develop hepatomegaly due to intrahepatic glycogen deposition. If these patients also have elevated liver enzymes, dyslipidemia, cushingoid features and delayed growth or sexual maturation, Mauriac syndrome can be diagnosed. This disorder is common and reversible with optimization of insulin therapy. We report three adolescents with type 1 diabetes and a long-standing history of poor glycemic control, who developed hepatomegaly, elevated liver enzymes and dyslipidemia with preserved liver function. One of these patients also had delayed growth and another had hypogonadotropic hypogonadism. Liver ultrasound showed changes suggestive of glycogenosis. In all three patients, optimization of insulin therapy achieved good glycemic control and reversed the manifestations within 2 weeks. The etiology of Mauriac syndrome is controversial since both prolonged hyperglycemia and hyperinsulinization produce glycogen accumulation in the liver. Hypercortisolism (due to ketosis or hypoglycemia) contributes to glycogen storage and also causes growth and sexual maturation delay.

Hepatomegalia por depósito de glucógeno hepático y diabetes mellitus tipo 1 / Hepatomegaly due to glycogen storage disease and type 1 diabetes mellitus

Los pacientes diabéticos tipo 1 con mal control metabólico pueden desarrollar hepatomegalia secundaria al depósito de glucógeno intrahepático. Si además presentan hipertransaminasemia, dislipemia, rasgos cushingoides, y retraso del crecimiento y del desarrollo puberal podemos hablar de síndrome de Mauriac. Este síndrome es frecuente y reversible con la optimización del tratamiento insulínico. Presentamos 3 adolescentes diabéticos tipo 1 de larga evolución con mal control metabólico que manifestaron hepatomegalia, hipertransaminasemia y dislipemia con funcionalismo hepático normal. Uno de ellos presentó retraso de crecimiento y otro hipogonadismo hipogonadotropo. Las ecografías hepáticas mostraron glucogenosis. El cuadro revirtió en todos ellos con la optimización de la insulinoterapia manteniendo controles glucémicos normales en el plazo de 2 semanas. La etiología del síndrome Mauriac es controvertida pues tanto la hiperglucemia mantenida como la hiperinsulinización producen glucogenosis. La hipercortisolemia también (fruto de la cetosis o hipoglucemia) y además produce retraso de crecimiento y del desarrollo puberal

Patients with type 1 diabetes and poor metabolic control can develop hepatomegaly due to intrahepatic glycogen deposition. If these patients also have elevated liver enzymes, dyslipidemia, cushingoid features and delayed growth or sexual maturation, Mauriac syndrome can be diagnosed. This disorder is common and reversible with optimization of insulin therapy. We report three adolescents with type 1 diabetes and a long-standing history of poor glycemic control, who developed hepatomegaly, elevated liver enzymes and dyslipidemia with preserved liver function. One of these patients also had delayed growth and another had hypogonadotropic hypogonadism. Liver ultrasound showed changes suggestive of glycogenosis. In all three patients, optimization of insulin therapy achieved good glycemic control and reversed the manifestations within 2 weeks. The etiology of Mauriac syndrome is controversial since both prolonged hyperglycemia and hyperinsulinization produce glycogen accumulation in the liver. Hypercortisolism (due to ketosis or hypoglycemia) contributes to glycogen storage and also causes growth and sexual maturation delay