Radiofrequency exposure in the Neonatal Medium Care Unit.

The aims of this study were to characterize electromagnetic fields of radiofrequency (RF-EMF) levels generated in a Neonatal Medium Care Unit and to analyze RF-EMF levels inside unit's incubators. Spot and long-term measurements were made with a dosimeter. The spot measurement mean was 1.51±0.48V/m. Higher values were found in the proximity to the window and to the incubator evaluated. Mean field strength for the entire period of 17h was 0.81 (±0.07)V/m and the maximum value was 1.58V/m for long-term RF-EMF measurements in the incubator. Values found during the night period were higher than those found during the day period. It is important to consider RF-EMF exposure levels in neonatal care units, due to some evidence of adverse health effects found in children and adults. Characterization of RF-EMF exposure may be important to further investigate the mechanisms and underlying effects of electromagnetic fields (EMF) on infant health. A prudent avoidance strategy should be adopted because newborns are at a vulnerable stage of development and the actual impact of EMF on premature infants is unknown.

Estudio de prevalencia del trastorno por déficit de atención e hiperactividad en niños en régimen de acogimiento residencial / Prevalence study of attention deficit hyperactivity disorder in children in residential care

INTRODUCCIÓN: Los niños que se encuentran en régimen de acogimiento residencial constituyen un colectivo de riesgo en el que los problemas médicos pueden alcanzar altas tasas, especialmente aquellos relacionados con la esfera psicológica, donde el trastorno por déficit de atención e hiperactividad (TDAH) es una de las alteraciones del neurodesarrollo más frecuentes. OBJETIVO: El propósito de este estudio fue determinar la prevalencia de TDAH en los niños de un centro de acogida en Albuñol (Granada) en 2016. Material y Métodos. En este estudio transversal se incluyeron los 106 niños de edades comprendidas entre los 5 y los 17 años del Centro Hogar "Cristo Rey". La evaluación psicométrica se basó en la Escala de Vanderbilt de TDAH. Las funciones ejecutivas se evaluaron mediante el Behavior Rating Inventory of Executive Function (BRIEF) en aquellos participantes que cumplieron los criterios de Vanderbilt, y también se aplicaron los criterios del DSM-5 en la entrevista clínica para reforzar el diagnóstico de TDAH. RESULTADOS: La prevalencia de TDAH fue del 17.9% en nuestro grupo, siendo el subtipo inatento el más frecuente. CONCLUSIONES: La prevalencia de TDAH en el centro de acogida "Cristo Rey" fue notablemente elevada en comparación con la prevalencia en niños de la población general. Es necesario seguir investigando acerca de las comorbilidades relacionadas con el TDAH en niños en régimen de acogimiento residencial. Deberían instaurarse programas de detección e intervención en centros de acogida por las repercusiones que puede llegar a tener el TDAH

INTRODUCTION: Children in residential care constitute a risk group in which medical problems can reach high rates, especially those concerned to the psychological sphere, including attention deficit hyperactivity disorder (ADHD), one of the most common neurodevelopmental disorders. OBJECTIVE: The purpose of this study was to determine the prevalence of ADHD in children in a foster care institution in Albuñol (Granada) in 2016. MATERIALS AND METHODS: This cross-sectional descriptive study included 106 children aged 5 to 17 years from "Cristo Rey" foster care institution. Psychometric evaluation was based on Vanderbilt ADHD Diagnostic Rating Scale. Executive functions were tested using the Behavior Rating Inventory of Executive Function (BRIEF) in participants who met Vandebilt criteria, as well Diagnostic and DSM- 5 criteria were applied in a clinical interview to strengthen ADHD diagnosis. RESULTS: The prevalence of ADHD was determined to be 17.9 % in our group, with innatentional subtype being the most important. CONCLUSION: Prevalence of ADHD in "Cristo Rey" foster care institution was visibly high in comparison with estimated prevalence in children general population. Research is needed to identify comorbidities in children in residential care suffering from ADHD. ADHD detection and intervention programmes in residential care must be developed because of its repercussion

Reflexiones sobre la neurotoxicidad inducida por opioides en el contexto de una anestesia general en población pediátrica / Opioid related neurotoxicity on pediatric population after general anestesia

Introducción: Desde el año 2000 vienen apareciendo en distintas publicaciones científicas los resultados de numerosos estudios experimentales realizados en animales, evaluando el impacto neurotóxico que sobre sus cerebros tenía la exposición a combinaciones de anestésicos de uso habitual. Se constata que la exposición en periodo de máxima sinaptogénesis conlleva una apoptosis neural diseminada. Comienzan entonces a preocuparse los anestesiólogos que trabajan con niños, pues quizás ese daño neuronal también pudiera acontecer a la población pediátrica. Así, son varios los estudios que están en marcha desde hace años valorando el desarrollo neurocognitivo de cohortes de niños que se sometieron a anestesias generales en edades tempranas de sus vidas. En este sentido, la necesidad de medir un daño cerebral agudo nos anima a utilizar marcadores que han demostrado su asociación con dicho deterioro cerebral en diferentes situaciones clínicas como la hipoxia perinatal, la parada cardiorrespiratoria o el traumatismo craneoencefálico. Objetivos: Planteamos este trabajo con el objetivo de determinar si la proteína S100B podría comportarse como un biomarcador de daño cerebral agudo postanestésico y si pudiéramos establecer asociación entre la elevación de este marcador en sangre y alguno de los fármacos anestésicos utilizados habitualmente. Metodología: Determinación sanguínea de la proteína S100B en 76 pacientes pediátricos intervenidos de hipertrofia amigdalar bajo anestesia general, antes y después de la cirugía Conclusión: Tras analizar los resultados podemos concluir que existe una elevación estadísticamente significativa entre los niveles de proteína S100B antes y después de la exposición anestésica. En segundo lugar, podemos establecer una correlación positiva, también con significación estadística, entre el fentanilo administrado y la elevación de dicha proteína al final del acto anestésico (AU)

Introduction: In the last decade many scietific publications bring out the results of experimental studies about the neurotoxic impact of an anesthetic expossure in animal´s brain. It is confirm that when this expossure occurs in a maximum synaptogenesis period of the animal´s live a widespread neuroapoptosis befall. From there on all the pediatrics anesthesiologist warried about if this damage could also affect the pediatric population. Nowadays there are several observational studies exploring the neurobehavioral conduct of many children who underwent general anesthesia early in their lives. Objetive: As a results of this we propose to use actual neuronal damage biomarkes, wich have demonstrated association between brain damage and perinatal hypoxia, or cardiac arrest or mild brain injury. When we planned this essay we intend to determine if S100B protein could work as an accute postanesthetic expossure neuronal damage biomarker, and if there would be any relationship between the biomarker elevation and any of the drugs commonly use for anesthesia. Metodology: In order to determinate the S100B protein serum level is, we obtained a blood sample before and after general anaesthesia expousure in 76 paediatric patient undergoing amigdalar hypertropy surgery. Conclusions: Once we analized our results we can coclude that an elevation of the blood levels of S100B protein occurs after anesthesia. We have also found a possitive correlation between the total amount of fentanyl administred and the higher level of this protein concentration at the end of the anesthetic expossure (AU)

Problemas de salud prevalentes en los menores en centros de acogida / Prevalent health problems of children in residential care centers

Introducción: La población infantil sujeta a medidas de protección es una franja de población vulnerable, no sólo desde el punto de vista social, sino también sanitario. La principal limitación detectada en la bibliografía recientemente revisada es la escasez de estudios que evalúen la situación sanitaria de los menores durante su estancia en el sistema de protección. Nos proponemos analizar el estado de salud de una población en programa residencial básico, atendiendo a las diferencias entre grupos etarios, así como la asociación de distintas variables con el tiempo de institucionalización. Material y métodos: Se diseña un estudio transversal, realizándose dos visitas a los 26 centros de la provincia de Granada (entre diciembre de 2006 y marzo de 2007). En la primera se revisan los expedientes de los menores y en la segunda se procede a su valoración clínica. En cuanto al estudio estadístico, la muestra se distribuye en tres grupos de edad (0-5, 6-12 y 13-18 años), y se realiza el análisis comparativo y la inferencia estadística mediante las pruebas de la chi2, Kruskal-Wallis y Mann-Whitney. Resultados: Se revisa un total de 294 menores. La prevalencia global de desnutrición es del 4%, más frecuente en el grupo de 0-5 años, y la de sobrepeso del 18%, más habitual en el grupo de 6-12 años. Las alteraciones más frecuentemente detectadas son otorrinolaringológicas (ORL) (63,9%), dermatológicas (34,9%) –más prevalentes en los menores de 12 años– y conductuales (28,1%), más frecuentes en los mayores de 6 años. El seguimiento en consultas especializadas fue del 40%. En cuanto al tiempo de estancia en la institución, se observaron mayores estancias en los menores con un diagnóstico psicopatológico y con un mayor número de seguimientos en las consultas especializadas (AU)

Conclusiones: El estado de salud de los menores institucionalizados se podría considerar adecuado en líneas generales. Las principales diferencias con la población general derivan de la existencia de tasas de desnutrición algo superiores en los menores de 0-5 años y una alta prevalencia de patología ORL, dermatológica, mental y conductual. Cabe destacar la vulnerabilidad del grupo de niños de 6-12 años con un número más elevado de necesidades sanitarias (AU)

Introduction: Children under protection measures constitute a vulnerable population from both social and health standpoints. The main limitation detected in a review of the recent literature is the scarcity of studies on the health status of minors during their stay in the protection system. We proposed to study the health status of a population in a basic residential care program, investigating differences among age groups and analyzing the association of different variables with time of institutionalization. Methods: A cross-sectional study was designed that involv­ed two visits to the centres: the first to review the records of the minors and the second to carry out physical examinations. For the statistical study, the sample was divided into three age groups (0-5, 6-12 and 13-18 yrs) and the chi2, Kruskal-Wallis and Mann-Whitney tests were used for comparative analyses and statistical significances. Results: We revised 294 children. Prevalence of global malnutrition was 4%, highest in the 0-5-yr group; prevalence of overweight was 18%, highest in the 6-12-yr group. The most frequent disorders were: ENT (63.9%); dermatological (34.9%), most prevalent in children <12 yrs; and behavioural (28.1%), most prevalent in children >6 yrs old; 40% were under specialist follow-up. Longer stays in the institution were associated with a psychopathological diagnosis and higher frequency of specialist follow-up. Conclusions: The health status of institutionalised minors can in general be considered adequate. The main differences with the general population derive from the presence of somewhat higher malnutrition rates in the 0 to 5-year-olds and an elevated prevalence of ENT, dermatological, psychological and behavioural pathologies. We highlight the vulnerability of 6 to 12-year-olds, who have a larger number of healthcare needs (AU)

Hypertension and Biliary Ductopenia in a Patient with Duplication of Exon 6 of the JAG1 Gene.

We describe a neonatal patient with biliary ductopenia featuring duplication of exon 6 of the JAG1 gene. Facial alterations were observed, consisting of a prominent forehead, sunken eyes, upward slanting palpebral fissures, hypertelorism, flat nasal root and prominent chin. From birth, these were accompanied by the development of haematuria and renal failure and by renal Doppler findings indicative of peripheral renal artery stenosis. JAG1 gene mutations on chromosome 20 have been associated with various anomalies, including biliary cholestasis, vertebral abnormalities, eye disorders, heart defects and facial dysmorphia. This syndrome, first described by Alagille, is an infrequent congenital disorder caused by a dominant autosomal inheritance with variable expressivity. Anatomopathological effects include the destruction and disappearance of hepatic bile ducts (ductopenia). The duplication of exon 6 of JAG1 has not previously been described as an alteration related to the Alagille syndrome with peripheral renal artery stenosis.

Urinary excretion of phenolic acids by infants and children: a randomised double-blind clinical assay.

OBJECTIVES: The present study, which is part of the ISRCTN16968287 clinical assay, is aimed at determining the effects of cranberry syrup or trimethoprim treatment for UTI. METHODS: This Phase III randomised clinical trial was conducted at the San Cecilio Clinical Hospital (Granada, Spain) with a study population of 192 patients, aged between 1 month and 13 years. Criteria for inclusion were a background of recurrent UTI, associated or otherwise with vesico-ureteral reflux of any degree, or renal pelvic dilatation associated with urinary infection. Each child was randomly given 0.2 mL/Kg/day of either cranberry syrup or trimethoprim (8 mg/mL). The primary and secondary objectives, respectively, were to determine the risk of UTI and the levels of phenolic acids in urine associated with each intervention. RESULTS: With respect to UTI, the cranberry treatment was non-inferior to trimethoprim. Increased urinary excretion of ferulic acid was associated with a greater risk of UTI developing in infants aged under 1 year (RR 1.06; CI 95% 1.024-1.1; P = 0.001). CONCLUSIONS: The results obtained show the excretion of ferulic acid is higher in infants aged under 1 year, giving rise to an increased risk of UTI, for both treatment options.

Normalization of the sleep-wake pattern and melatonin and 6-sulphatoxy-melatonin levels after a therapeutic trial with melatonin in children with severe epilepsy.

This study evaluated the sleep-wake pattern, plasma melatonin levels and the urinary excretion of its metabolite, 6-sulphatoxy-melatonin among children with severe epileptic disorders, before and after a therapeutic trial with melatonin. Ten paediatric patients, suffering from severe epileptic disorders, were selected and given a nightly dose of 3 mg of a placebo, for 1 wk; for the next 3 months, the placebo was replaced with a nightly dose of 3 mg of melatonin. At the end of each treatment period, the urinary excretion of 6-sulphatoxy-melatonin (for the intervals 09.00 - 21:00 hr or 21:00-09:00 hr) and plasma levels of melatonin (recorded at 01:00, 05:00, 09:00, 13:00, 17:00 and 21:00 hr) were recorded, over a period of 24 hr; an actigraph record was also kept. Sleep efficiency among patients who received melatonin was significantly higher than among those given the placebo, with fewer night-time awakenings. Periodic plasma melatonin levels were regained and a better control gained of convulsive episodes, in that the number of seizures decreased. We conclude that melatonin is a good regulator of the sleep-wake cycle for paediatric patients suffering from severe epilepsy, moreover, it to a better control of convulsive episodes.

Melatonin and elimination of kynurenines in children with Down's syndrome.

BACKGROUND: Heightened activity of superoxide dimutase is an effect derived from the gene dose in the trisomy of Down's syndrome (DS), and has been related to the increased production of hydrogen peroxide and with greater lipid peroxidation. Many of the degenerative changes observed in patients with DS have been associated with the pathological effects of free radicals, and for this reason it is of interest to determine the levels present in these patients of powerful antioxidant molecules such as melatonin, and of metabolites with important neuroprotector and neurotoxic consequences such as those derived from the kynurenine pathway. PATIENTS AND METHODS: A study was made of 15 children with DS, together with a control group of 15 non-DS children, matched for age and sex, examined at the Hospital Costa del Sol, Marbella, Spain. Serum melatonin and serotonin were analyzed by RIA; urinary tryptophan metabolites (kynurenine pathway) were determined during periods of light and darkness (09.00-21.00 h and 21.00-9.00 h) by thin-layer chromatography. RESULTS: The mean values of serotonin and melatonin were found to be lower in the patients with DS, although the level of nocturnal secretion of melatonin was higher. Urinary excretion of kynurenine was lower in the patients with DS, although greater quantities of kynurenic acid and anthranilic acid were excreted. CONCLUSIONS: Patients with DS present levels of plasma melatonin and urinary kynurenine that are lower than the corresponding levels in the control population, together with higher values of kynurenic acid and anthranilic acid. These circumstances constitute an added risk to these patients of damage by free radicals.

Overweight and obesity as risk factors for the asymptomatic carrier state of Neisseria meningitidis among a paediatric population.

We analysed the asymptomatic carrier state of Neisseria meningitidis in a sample of 339 children. We obtained data for the children's weight and height, in order to calculate the body mass index (BMI). The cutoff points defined by Cole were employed in determining the BMI, and the population was divided into three groups: normal, overweight and obese. Twenty carriers of N. meningitidis were identified. There was found to be a statistically significant trend to increased risk of being a carrier with increased BMI (z=2.03; P=0.04); after adjusting for age using the Mantel-Haenszel weighting method, this relationship was strengthened (z=2.38; P=0.01). Paediatric patients with increased BMI in the range of obesity present a three times greater risk of being carriers of N. meningitidis than non-obese patients, with a trend for this risk to increase with higher BMI.

Effects on the glutathione pool of the insulin-induced hypoglycaemia test.

The growth hormone (GH) stimulation test shows that hypoglycaemia can cause the generation of free radicals, or reactive oxygen species (ROS), together with the migration of amino acids, glutathione and various ions to the interior of fat or muscle cells. The aim of the present study is to evaluate the splitting of plasma glutathione into its two fractions, oxidized (GSSG) and reduced (GSH), after the induction of hypoglycaemia with insulin in the course of the GH stimulation test. We studied 41 short children (47% boys and 53% girls) at the Paediatric Department of the San Cecilio Hospital (Granada, Spain) to evaluate their size and growth. A GH stimulation test using insulin-induced hypoglycaemia was carried out, and GSSG and GSH values in plasma were determined. The glutathione level is associated with the level of glucose reached at 30 min after initiating the test. This provoked an initial reduction in the GSH/GSSG ratio, which fell to a minimum at 30 min after starting the test, although the values rose again at 60 min. The results obtained show that the insulin-induced GH stimulation test produces a decrease in plasma levels of the glutathione pool, that persists at least for 2 hours following the beginning of the test.

Serum melatonin concentration in the child with non-organic failure to thrive: comparison with other types of stress.

Human beings must adapt both to novel, unfavourable conditions and to circumstances of physical or psychological isolation. The initial response to stress depends fundamentally on the activation of the HPA axis. In regaining homeostatic equilibrium, melatonin plays a role due to its synchronising and anti-stress properties. To study the role of melatonin and the pineal gland in the organic and/or behavioural response to acute or chronic stress, 311 children were divided into two large groups: 1) Control Group - 121 healthy children classified, in turn, into 4 control subgroups, one for each pathology being studied; 2) Problem Groups, classified as traumatic stress (n=58), surgical stress (n=38), psychic stress (n=64) and febrile stress (n=30), according to pre-established clinical criteria. These groups were sub-classified according to the degree (low or high) and duration (acute or chronic) of the stress. This study used a case controlled, cross sectional design. Serum melatonin was measured by radioimmunoassay (RIA). In all the situations of acute stress, melatonin increased at a rate directly proportional to the severity and/or duration of the stress-causing stimulus. In contrast, in chronic stress, i.e. the Affective Deprivation Syndrome (or Psychological Dwarfism) with or without non-organic failure to thrive, resulted in the opposite response with a significant reduction of melatonin. In conclusion, in acute stress an increase in the bioavailability of melatonin could contribute to maintaining homeostatic balance. The lack of an appropriate response to acute stress could make some groups of patients (Affective deprivation syndrome with or without growth failure) predisposed to suffer depressive symptoms associated with a wide range of neurological, endocrinological or immunological consequences.

[Castleman's disease: presentation of an atypical case]. / Enfermedad de Castleman: un caso de presentación atípica.

Castleman's disease is an unknown etiology lymphoproliferative disorder rare in childhood (only 100 cases described in the literature, 7 of them in Spain). It usually appears in young adults, with no gender-related differences. There are two clinical forms of the disease: the localized variant, the more frequent type, usually presented as a solitary mass (generally in the mediastinum) and asymptomatic at the time of diagnosis, and the multicentric variant, less frequent and usually associated with systemic symptoms and a more aggressive clinical evolution. The diagnosis is confirmed based on the histopathological study. There are two histological variants: the hyaline-vascular type, which usually appears as a localised variant, and the plasma-cell type, which usually appears as multicentric variant and has a worse prognosis. While the best treatment for the localised variant is surgical resection, which is curative, for the multicentric variant many therapeutic strategies have been used without real success. In the present article we report a new case of this disease in a 3-year-old girl with the localised form, who remains asymptomatic after two years of follow-up, and a review of the available literature. This disease should be included in the differential diagnosis of the lymphoproliferative disorders.

Enfermedad de Castleman: un caso de presentación atípica / Castleman´s disease: presentation of an atypical case

La enfermedad de Castleman es un trastorno linfoproliferativo de etiología desconocida, de escasa frecuencia en Pediatría (sólo hay 100 casos descritos, 7 en España). Suele afectar a adultos jóvenes y se describen 2 formas clínicas: la forma localizada (que suele presentarse como una masa única y asintomática al diagnóstico) y la forma multicéntrica, (generalmente con afectación sistémica y un comportamiento más agresivo). El diagnóstico de confirmación es anatómico y patológico. Histológicamente hay 2 variantes: la forma hialina-vascular, que suele corresponder a las formas localizadas de la enfermedad, y la variante de células plasmáticas, que suele ser multicéntrica. La resección quirúrgica es curativa para las formas localizadas, mientras que se han ensayado una multitud de tratamientos sin éxito para las formas multicéntricas. A continuación se presenta el caso de una preescolar de 3 años con una forma localizada de la enfermedad que, tras 2 años de seguimiento, se mantiene asintomática. Asimismo, se realiza una revisión de la literatura médica disponible al respecto (AU)

Castleman´s disease is an unknown etiology lymphoproliferative disorder rare in childhood (only 100 cases described in the literature, 7 of them in Spain). It usually appears in young adults, with no gender-related differences. There are two clinical forms of the disease: the localized variant, the more frequent type, usually presented as a solitary mass (generally in the mediastinum) and asymptomatic at the time of diagnosis, and the multicentric variant, less frequent and usually associated with systemic symptoms and a more aggressive clinical evolution. The diagnosis is confirmed based on the histopathological study. There are two histological variants: the hyaline-vascular type, which usually appears as a localised variant, and the plasma-cell type, which usually appears as multicentric variant and has a worse prognosis. While the best treatment for the localised variant is surgical resection, which is curative, for the multicentric variant many therapeutic strategies have been used without real success. In the present article we report a new case of this disease in a 3-year-old girl with the localised form, who remains asymptomatic after two years of follow-up, and a review of the available literature. This disease should be included in the differential diagnosis of the lymphoproliferative disorders (AU)

[Prevalence of atopic dermatitis in schoolchildren in Granada, Spain]. / Prevalencia de dermatitis atópica en escolares de Granada.

INTRODUCTION: Atopic dermatitis is a common and increasingly prevalent disorder. The International Study of Asthma and Allergies in Childhood (ISAAC) made a major contribution to the understanding of its epidemiology. OBJECTIVES: The aim of this study was to estimate the prevalence and severity of atopic dermatitis in a representative sample of 6 to 7-year-old and 13 to 14-year-old children from the province of Granada, Spain, using validated questionnaires and to analyze potential differences between coastal and inland regions. MATERIAL AND METHODS: This was a descriptive cross-sectional observational study of schoolchildren from Granada, Spain, aged between 6 and 7 years and 13 and 14 years. The main instrument was the core questionnaire module for dermatitis used in phase I of the ISAAC study. RESULTS: Statistically significant differences were found in Granada schoolchildren aged 6 to 7 years in terms of prevalence of dermatitis at some time, typical site, resolution in the last 12 months, and diagnosis of atopic dermatis. No significant differences were observed on comparison of the prevalence of atopic dermatitis between coastal and inland populations. Finally, in the comparison of schoolchildren aged 6 to 7 years, we observed almost significant differences for dermatitis at some time, resolution in the last 12 months, and diagnosis of atopic dermatitis on considering age and geographic location of the study population. CONCLUSIONS: The prevalence of atopic dermatitis is similar in the coastal population and the provincial capital. In terms of clinical symptoms and disease course, atopic dermatitis tends to stabilize with age.

Prevalencia de dermatitis atópica en escolares de Granada / Prevalence of atopic dermatitis in schoolchildren in Granada, Spain

Introducción. La dermatitis atópica (DA) es una enfermedad frecuente cuya prevalencia se ha incrementado progresivamente. En el conocimiento sobre su epidemiología ha desempeñado un papel muy importante el estudio ISAAC (International Study of Asthma and Allergy in Childhood).Objetivos. Estimar la prevalencia y gravedad de la DA en niños de 6-7 y 13-14 años de la provincia de Granada a partir de una muestra representativa mediante encuestas validadas y analizar si existen diferencias, comparando las zonas costeras con el interior. Material y métodos. Diseño observacional descriptivo transversal de base escolar. La población de estudio fue el alumnado de 6-7 y 13-14 años de Granada. Como instrumento de medición se utilizó el «cuestionario central para dermatitis» que el estudio ISAAC empleó en su primera fase. Resultados. Respecto a la prevalencia de síntomas en escolares granadinos según edad, se observaron diferencias estadísticamente significativas en escolares de 6-7 años en cuanto a «prevalencia de dermatitis alguna vez», «localización típica», «desaparición en los últimos 12 meses» y «diagnóstico de DA». Respecto a la prevalencia según zona geográfica, no hemos encontrado diferencias estadísticamente significativas. Finalmente, objetivamos diferencias casi significativas para la población de 6-7 años en la prevalencia de «dermatitis alguna vez», «desaparición en los últimos 12 meses» y «diagnóstico de DA» al relacionar los síntomas con la edad y la zona geográfica de la población de estudio. Conclusiones. La población costera y la de la capital ofrecen una prevalencia similar. Bajo una perspectiva clínico-evolutiva la dermatitis atópica tiene tendencia a estabilizarse con la edad (AU)

Introduction. Atopic dermatitis is a common and increasingly prevalent disorder. The International Study of Asthma and Allergies in Childhood (ISAAC) made a major contribution to the understanding of its epidemiology. Objectives. The aim of this study was to estimate the prevalence and severity of atopic dermatitis in a representative sample of 6 to 7-year-old and 13 to 14-year-old children from the province of Granada, Spain, using validated questionnaires and to analyze potential differences between coastal and inland regions. Material and methods. This was a descriptive cross-sectional observational study of schoolchildren from Granada, Spain, aged between 6 and 7 years and 13 and 14 years. The main instrument was the core questionnaire module for dermatitis used in phase I of the ISAAC study. Results. Statistically significant differences were found in Granada schoolchildren aged 6 to 7 years in terms of prevalence of dermatitis at some time, typical site, resolution in the last 12 months, and diagnosis of atopic dermatis. No significant differences were observed on comparison of the prevalence of atopic dermatitis between coastal and inland populations. Finally, in the comparison of schoolchildren aged 6 to 7 years, we observed almost significant differences for dermatitis at some time, resolution in the last 12 months, and diagnosis of atopic dermatitis on considering age and geographic location of the study population. Conclusions. The prevalence of atopic dermatitis is similar in the coastal population and the provincial capital. In terms of clinical symptoms and disease course, atopic dermatitis tends to stabilize with age (AU)

Influence of the antioxidant content of saliva on dental caries in an at-risk community.

OBJECTIVE: This study aims to evaluate the relationship between the total antioxidant capacity of saliva and the presence of dental caries in deciduous and permanent teeth, in a group of Saharan children. METHODS: The dental examination was carried out in accordance with the recommendations of the World Health Organization (WHO). The total antioxidant capacity of the saliva was determined by colorimetry. RESULTS: The total antioxidant capacity (TAC) of the saliva of patients with caries in deciduous teeth was 2.89 1/IC50 greater than among those without. We observed a statistically significant linear regression between the number of deciduous teeth affected by caries and the total antioxidant capacity of the saliva: y = 0.24 + 0.53 x TAC saliva (t = 2.93; p = 0.004) (95% CI of b: 0.018-0.088). CONCLUSIONS: Our results show that the amount of caries in deciduous teeth is in direct proportion to the observed TAC of saliva, and that the presence of caries in deciduous teeth is associated with caries in permanent teeth.

Neuroendocrine and circadian aspects (melatonin and beta-endorphin) of atopic dermatitis in the child.

Atopic dermatitis (AD) is a disease of increasing incidence among paediatric patients. Among the factors involved in its pathogenesis is the alteration of the immune response, and so the objective of this study was to evaluate the involvement of certain neuroendocrine factors with immune properties in the development of the disease. Fifty-five subjects were selected and divided into the following three groups: healthy subjects, those diagnosed with symptomatic AD and those with asymptomatic AD. Plasma levels of melatonin and beta-endorphins were measured by radioimmunoassay, in serum samples obtained at 9 am and 9 pm, with two samples being obtained from each of the patients and controls. In the phases of AD outbreaks, there is a reduction in the serum levels of both melatonin and beta-endorphin. In the case of melatonin, the difference is statistically significant only during the day, although nocturnal levels are greater for both hormones. In AD, a central neuroendocrine dysfunction may be a primary pathogenic event. Our hypothesis is that the physiological nocturnal peak of melatonin due to pineal gland production may mask the decline of melatonin of possibly extrapineal (immunological) origin during episodes of dermatitis outbreaks. Further studies are required, particularly of neurovegetative and hormonal aspects, to better define this process. Such a definition would also be of therapeutic interest.

Melatonin increases following convulsive seizures may be related to its anticonvulsant properties at physiological concentrations.

Melatonin ( N-acetyl-5-methoxytryptamine, aMT) is an indoleamine produced by several organs and tissues including the pineal gland. Melatonin (aMT) modulates the activity of the brain, mainly acting on both GABA and glutamate receptors. Previous studies have shown the participation of melatonin in the control of convulsive crises, suggesting that aMT concentration increases during seizures, and that patients with seizures of diverse origins show an alteration of the aMT rhythm. However, what is not known is the duration of the aMT response to seizures, and whether aMT changes during seizures could be a marker of the disease. For this reason, the serum levels of aMT in 54 children with a convulsive crisis, febrile and epileptic, were analyzed during the crisis, as well as at 1 h and 24 hours after the seizure. The results show that aMT significantly increases during the seizure (Day group, 75.64+/-45.91 and Night group, 90.69+/-51.85 pg/mL), with normal values being recovered 1 h later (Day group, 26.33+/-10.15 and Night group, 27.78+/-7.82 pg/mL) and maintained for up to 24 hours, when the circadian variation of aMT returns to the normal acrophase. Due to the interindividual variation of aMT levels among healthy people, a single determination of the indoleamine concentration is not a suitable marker of the existence of a convulsive crisis unless the circadian profile of aMT secretion in the patient is known. The results obtained also support the view that the stimulation of aMT production by the convulsive crisis may participate in the response of the organism against the seizures.

Melatonin levels during the first week of life and their relation with the antioxidant response in the perinatal period.

AIM: Melatonin is a potent free radical scavenger and an indirect antioxidant. Knowledge about the behavior of melatonin secretion in the early neonatal period, which may relate to its properties at a vital stage during very high antioxidant demands, is limited. PATIENTS AND METHODS: We studied 35 newborns admitted to the Neonatal Unit with respiratory distress syndrome (RDS) and with no signs of sepsis, severe anemia, hemodynamic compromise or malformation. The gestational age of the newborns was 26-40 weeks (mean value 32.5 weeks) and the weight at birth was 870-4,400 g (mean value 1,800 g). They were classified into two groups: 1,500 g birthweight. In all cases, at 09:00 h on their 1st, 3rd and 7th days of life, serum melatonin was measured by RIA. The clinical history was recorded and treatment and follow-up were performed according to established neonatology practice, and the resultant data recorded. Informed consent from the parents or guardians was obtained in accordance with the Declaration of Helsinki. Statistical analysis was carried out using ANOVA-II (factor I: day of sample; factor II: birthweight). RESULTS: There were significant increases in melatonin levels with increasing birthweight (p = 0.017), but no changes by day of sample. Although in both study groups melatonin levels increased during the first few days this was not statistically significant. CONCLUSIONS: In newborns of low birthweight, we report high melatonin concentrations in the morning and during the first week of life. These increase with maturation, and at full-term were similar to nocturnal levels during the acrophase of pineal gland secretion in toddlers and schoolage children, when pineal gland secretion is maximal and takes place reflecting environmental variations. In the early neonatal period these high levels of melatonin seem to derive from extrapineal sources, which mature to provide antioxidant protection in accordance with other elements of the antioxidant network to compensate for the high levels of oxidative stress that are present in the perinatal period.