Epidemiología de la enfermedad celíaca pediátrica en dos Áreas Sanitarias de Asturias / EPIDEMIOLOGY OF PEDIATRIC CELIAC DISEASE IN TWO HEALTH AREAS OF ASTURIAS (SPAIN)

Introducción y objetivos. En las últimas décadas se ha descrito un aumento de la incidencia de enfermedad celíaca (EC) y un predominio de formas de presentación menos sintomáticas. El objetivo de este estudio es describir las características clínicas de la EC en población pediátrica de dos Áreas Sanitarias de Asturias y estimar su incidencia. Pacientes y métodos. Estudio observacional, prospectivo y multicéntrico de pacientes de las Áreas Sanitarias III (Avilés) y V (Gijón) incluidos en el Registro Español de Pacientes Celíacos pediátricos REPAC2 (2011-2017). Se recogieron datos demográficos, síntomas, somatometría y pruebas diagnósticas. Se utilizaron criterios ESPGHAN 2020 para el estudio descriptivo y el cálculo de la incidencia, y criterios ESPGHAN 2012 para el análisis comparativo con el resto de España. Resultados. Se incluyen 99 casos (50,5% niñas): 72 del Área V y 27 del Área III. Mediana de edad: 3,1 años (P25-P75: 1,6-7,7). La forma de presentación más frecuente fue la EC clásica (76,8%), con un 2,0% de asintomáticos. Los síntomas más frecuentes fueron la pérdida/estancamiento de peso (55,7%) y la diarrea (49,5%). Respecto al resto de España (4.681 casos), en Asturias (82 casos) se registró una menor frecuencia de asintomáticos (2,4% vs. 9,8%, p=0,026) y de realización de biopsias (28% vs. 62,1%, p<0,001). La tasa de incidencia de EC basada en diagnósticos hospitalarios fue de 32,1 (IC95%: 26,1-39,1) por 100.000 personas/año. Conclusiones. Se identifican diferencias geográficas en la presentación y diagnóstico de EC, y una mayor incidencia respecto a estudios previos. (AU)

Introduction and aims. Over the last few decades, it has been reported an increase in the incidence of celiac disease (CD) and a predominance of less symptomatic clinical presentations. This study aimed to describe the clinical characteristics of CD in the paediatric population of two Health Areas of Asturias and to estimate its incidence. Patients and methods. Observational, prospective, multicentre study of patients from Health Areas III (Avilés) and V (Gijón) included in the Spanish Registry of Paediatric Celiac Patients REPAC2 (2011-2017). Demographic data, symptoms, somatometry and diagnostic tests were collected. The incidence rate was calculated using the municipal register. ESPGHAN 2020 diagnostic criteria were used for the descriptive study and incidence calculation, and ESPGHAN 2012 criteria were used for the comparative analysis with the rest of Spain. Results. 99 patients (50.5% girls) were included: 72 from Area V and 27 from Area III. Median age: 3.1 years (P25-P75: 1.6-7.7). The most frequent clinical presentation was classic CD (76.8%), whereas 2.0% were asymptomatic. The most frequent symptoms were failure to thrive (55.7%) and diarrhoea (49.5%). Compared with the rest of Spain (4681 patients), Asturias (82 patients) had fewer asymptomatic patients (2.4% vs. 9.8%, p=0.026) and fewer biopsies performed (28% vs. 62.1%, p<0.001). The incidence rate of CD based on hospital diagnoses according to ESPGHAN 2020 criteria was 32.1 (95%CI: 26.1-39.1) per 100,000 person-years. Conclusions. Geographic differences were identified in the presentation and diagnosis of CD, with a higher incidence compared to previous studies. (AU)

Utilidad de un preparado lácteo con fibra en el estreñimiento funcional infantil / Utility of lactic product with fiber in infant functional constipation

Objetivo: Evaluar la eficacia de un preparado lácteo suplementado con fibra en niños con estreñimiento funcional. Material y métodos: Ensayo clínico, aleatorizado, doble ciego, controlado con placebo. Se incluyeron 19 niños de entre 4 y 12 años con criterios de Roma III para estreñimiento funcional. El grupo de intervención recibió durante 4 semanas 200 ml al día de leche con fibra, mientras los controles recibieron una ración similar de leche sin suplementar. Resultados: Tras 4 semanas no se encontraron diferencias estadísticamente significativas entre grupos respecto a la realización de al menos 3 deposiciones a la semana (88,9% en tratados frente a 100% en controles, p = 0,474), número de deposiciones semanales, consistencia de deposiciones o presencia de conductas de retención, dolor con la defecación e incontinencia fecal, o la salud autopercibida. En ambos se observó tendencia al aumento en el número de deposiciones; en el grupo de tratamiento de 3,6 ± 1,9 a 5,8 ± 2,0 deposiciones/semana (p = 0,059) y en el grupo placebo de 3,3 ± 1,3 a 5,8 ± 1,3 deposiciones/semana (p = 0,001). También disminuyó la presencia de dolor con la defecación en el grupo de tratamiento del 77,8% al 11,1% (p = 0,031) y en placebo del 80,0% al 20,0% (p = 0,031). Conclusiones: No se ha podido confirmar la eficacia de un preparado lácteo con fibra para el estreñimiento funcional infantil. Son necesarios estudios bien diseñados y de mayor tamaño muestral para determinar el papel de los suplementos de fibra en los niños con estreñimiento

Objective: To assess the effectiveness of a fibre-fortified milk in children with chronic functional constipation. Patients and methods: Randomised, double-blind, placebo-controlled clinical trial involving 19 children, 4 to 12-year-old, who were diagnosis with functional constipation according to Rome III Criteria. Intervention group received 200 ml of fibre-fortified milk daily for 4 weeks, while the other group received a similar portion of nonfortified milk. Results: At the end of the intervention there were no statistically significant differences between groups with respect to having at least three bowel movements a week (88.9% in intervention group vs. 100% in control group, p = 0.474), frequency of bowel movements, stool consistency, presence of painful defecation, retentive posturing, or fecal incontinence, or self-reported perceived health. Both groups tended to increase bowel movements. Fibre group increased from 3.6 ± 1.9 to 5.8 ± 2.0 bowel movements/week (p = 0.059), while control group increased from 3.3 ± 1.3 to 5.8 ± 1.3 bowel movements/week (p = 0.001). Presence of painful defecation decreased both in fibre group, 77.8% to 11.1% (p = 0.031), and in control group, 80.0% to 20,0% (p = 0.031). Conclusions: Effectiveness of a fibre-fortified milk was not confirmed in children with chronic functional constipation. High quality clinical trials are required to know the efficacy of fibre supplements in children with functional constipation

Efectividad de una intervención escolar contra la obesidad / Effectiveness of a school-based program to prevent obesity

INTRODUCCIÓN: Las intervenciones sobre la obesidad infantil son una prioridad para la salud pública. El objetivo de este estudio fue evaluar la efectividad de un programa de intervención contra la obesidad en un colegio de Educación Primaria. MATERIAL Y MÉTODOS: Estudio de intervención controlado no aleatorizado en alumnos de primero a quinto cursos de Educación Primaria en 2 colegios públicos de Avilés (España). La intervención se desarrolló durante 2 cursos escolares, incluyendo talleres sobre alimentación saludable, charlas educativas, material informativo escrito y promoción de la actividad física. La variable de resultado principal fue la puntuación z del índice de masa corporal (IMC). Como variables de resultado secundarias se consideraron: prevalencia de obesidad y sobrepeso, perímetro abdominal, hábitos de dieta y actividad física. RESULTADOS: Fueron incluidos en el estudio 382 (177 niñas, 205 niños) de 526 alumnos de ambos colegios. En 340 individuos se obtuvieron datos antropométricos completos. A diferencia del grupo control, los pertenecientes al grupo de intervención disminuyeron la puntuación z del IMC desde 1,14 a 1,02 (p = 0,017), mejoraron el índice KIDMED de adhesión a la dieta mediterránea de 7,33 a 7,71 puntos (p = 0,045) y aumentaron la proporción de estudiantes con una dieta óptima del 42,6% al 52,3% (p = 0,021). No se encontraron diferencias estadísticamente significativas en la prevalencia de obesidad y sobrepeso, ni en el perímetro abdominal, entre los grupos de intervención y control. CONCLUSIONES: Este programa escolar consiguió pequeñas mejoras en el IMC y la calidad de la dieta

INTRODUCTION: Intervention for childhood obesity is a public health priority. The purpose of this study was to evaluatethe effectiveness of an elementary school-based intervention against obesity in children. MATERIAL AND METHODS: Non-randomised controlled trial was conducted on children from first to fifth grade from two public schools of Avilés (Spain). The intervention lasted for 2 school years comprising healthy diet workshops, educational chats, educational meetings, informative written material, and promotion of physical activities. Primary outcome measure was body mass index z-score. Secondary outcomes included: obesity and overweight prevalence, waist circumference, dietary habits, and physical activity. RESULTS: A total of 382 (177 girls, 205 boys) out of 526 pupils of both schools were included in the study. Complete anthropometric data were obtained in 340 of the 382 individuals. Compared to children in control group, those in intervention group decreased body mass index z-score from 1.14 to 1.02 (P=.017), and improved KIDMED score from 7.33 to 7.71 points (P=.045). The percentage of students who carried on an optimal diet increased from 42.6% to 52.3% (P=.021). There were no statistical differences in the prevalence of obesity and overweight, or in waist circumference between the intervention and control groups. CONCLUSIONS: This school-based program resulted in modest beneficial changes in body mass index and diet quality

[Effectiveness of a school-based program to prevent obesity]. / Efectividad de una intervención escolar contra la obesidad.

INTRODUCTION: Intervention for childhood obesity is a public health priority. The purpose of this study was to evaluate the effectiveness of an elementary school-based intervention against obesity in children. MATERIAL AND METHODS: Non-randomised controlled trial was conducted on children from first to fifth grade from two public schools of Avilés (Spain). The intervention lasted for 2 school years comprising healthy diet workshops, educational chats, educational meetings, informative written material, and promotion of physical activities. Primary outcome measure was body mass index z-score. Secondary outcomes included: obesity and overweight prevalence, waist circumference, dietary habits, and physical activity. RESULTS: A total of 382 (177 girls, 205 boys) out of 526 pupils of both schools were included in the study. Complete anthropometric data were obtained in 340 of the 382 individuals. Compared to children in control group, those in intervention group decreased body mass index z-score from 1.14 to 1.02 (P=.017), and improved KIDMED score from 7.33 to 7.71 points (P=.045). The percentage of students who carried on an optimal diet increased from 42.6% to 52.3% (P=.021). There were no statistical differences in the prevalence of obesity and overweight, or in waist circumference between the intervention and control groups. CONCLUSIONS: This school-based program resulted in modest beneficial changes in body mass index and diet quality.

Nuevos programas gratuitos para gestión de referencias bibliográficas / New free programs for the management of references

Uno de los retos a los que se enfrentan los profesionales sanitarios es la gestión y organización de la literatura científica a la que acceden en el desarrollo de sus actividades asistenciales, docentes e investigadoras. Los gestores de referencias bibliográficas son programas informáticos que ayudan al usuario a almacenar y organizar documentos y referencias bibliográficas, y que también facilitan las tareas de citación y elaboración de la bibliografía al redactar una publicación académica. Se repasa la evolución de los gestores de referencias en las últimas décadas hasta la aparición de nuevos programas disponibles de forma gratuita, ya sea en forma de programas de escritorio como de servicios web. Se revisan las características básicas de los tres gestores de referencias gratuitos más completos en el momento actual: Mendeley, Zotero y Colwiz. Como ejemplo, se describe con más detalle el funcionamiento de Mendeley. Los nuevos gestores de referencias bibliográficas gratuitos pueden cubrir las necesidades de la mayoría de profesionales sanitarios en la gestión integral de sus colecciones de documentos y referencias

Managing and classifying biomedical literature that health professionals store during healthcare, teaching, and research purposes is a huge challenge for them. Reference managers are software that helps scholars to store and organize documents and bibliographic references. They also make easier to manage bibliographic citations and creating bibliography when writing a scholarly manuscript. Reference managers evolution over the last decades, until the emergence of new software tools available free of charge either as desktop programs or as web services, is revised. Basic features of the three more complete free reference managers currently available -Mendeley, Zotero, and colwiz- are reviewed. As an example, use of Mendeley is described with more detail. New free reference managers are able to meet the needs of most health care professionals for comprehensive management of their documents and references collections

Eficacia y seguridad de una pauta rush de inducción de tolerancia oral en pacientes con alergia a proteínas de leche de vaca: evolución clínica e inmunológica / Oral rush desensitization for cow milk allergy: Clinical and immunological follow-up

Introducción: Evaluar la seguridad y la eficacia de la inducción de tolerancia oral mediante pauta rush en pacientes con alergia a proteínas de leche de vaca persistente. Material y métodos: Estudio prospectivo realizado en 3 hospitales españoles. Se incluyó a niños mayores de 3 años con alergia IgE-mediada a proteínas de leche de vaca, a los que se administraron dosis crecientes de leche durante 5 días, desde 1 cc al 1% hasta 200 cc de leche pura en régimen de hospital de día. Las reacciones adversas a la administración de leche fueron registradas y se trataron atendiendo a la clasificación de Clark. Se realizó seguimiento clínico durante 2 años. Se determinaron los niveles de IgE específica basales y a los 6, 12 y 24 meses. Resultados: Se incluyó a 18 niños (13 varones) entre 3 y 14 años (media 5,96). De 271 dosis administradas, 55 presentaron algún tipo de reacción. Un 84% de las mismas fueron leves. Al finalizar el protocolo, el 100% presentaba algún grado de tolerancia (39% total). Tras 2 años, el 72% de los pacientes realizaba una dieta sin restricción de productos lácteos. Dos pacientes presentaron pérdida de la tolerancia alcanzada. Se observó un descenso significativo de los niveles de IgE específica a leche de vaca y α-lactoalbúmina a los 24 meses, y de caseína a los 6, 12 y 24 meses respecto de los niveles basales. Conclusiones: La desensibilización mediante pauta rush es una opción terapéutica eficaz y segura a medio plazo para pacientes con alergia persistente a proteínas de leche de vaca (AU)

Objective: The aim of this study was to evaluate the safety and efficacy of oral rush desensitization in children with cow milk allergy. Material and methods: Prospective study. We included IgE-mediated cow milk allergy children over 3 years in 3 Spanish hospitals. Increasing doses of cow milk for 5 days from 1 cc of 1% to 200cc of pure milk were administered. Clinical follow-up was conducted and we compared specific IgE levels at onset, 6, 12 and 24 months after desensitization. Results: We included 18 children (13 males) between 3 and 14 years (mean 5.96). A total of271 doses were administered; there were 55 adverse reactions (84% mild). At the end of the protocol, 100% showed some degree of tolerance (39% total). Full tolerance was achieved in 72%of patients after two years. Two children failed to achieve tolerance. There was a significant decrease in the levels of specific IgE to cow milk and alpha-lactalbumin at 24 months, and to casein at 6, 12 and 24 months, compared to baseline. Conclusions: Oral rush desensitization is a safe and effective therapeutic option for patients with persistent cow milk allergy to medium term (AU)

[Oral rush desensitization for cow milk allergy: Clinical and immunological follow-up]. / Eficacia y seguridad de una pauta rush de inducción de tolerancia oral en pacientes con alergia a proteínas de leche de vaca: evolución clínica e inmunológica.

OBJECTIVE: The aim of this study was to evaluate the safety and efficacy of oral rush desensitization in children with cow milk allergy. MATERIAL AND METHODS: Prospective study. We included IgE-mediated cow milk allergy children over 3 years in 3 Spanish hospitals. Increasing doses of cow milk for 5 days from 1 cc of 1% to 200 cc of pure milk were administered. Clinical follow-up was conducted and we compared specific IgE levels at onset, 6, 12 and 24 months after desensitization. RESULTS: We included 18 children (13 males) between 3 and 14 years (mean 5.96). A total of 271 doses were administered; there were 55 adverse reactions (84% mild). At the end of the protocol, 100% showed some degree of tolerance (39% total). Full tolerance was achieved in 72% of patients after two years. Two children failed to achieve tolerance. There was a significant decrease in the levels of specific IgE to cow milk and alpha-lactalbumin at 24 months, and to casein at 6, 12 and 24 months, compared to baseline. CONCLUSIONS: Oral rush desensitization is a safe and effective therapeutic option for patients with persistent cow milk allergy to medium term.

Factores de riesgo cardiovascular clásicos y emergentes en escolares asturianos / Classic and emergent cardiovascular risk factors in schoolchildren in Asturias

Introducción: Los factores de riesgo cardiovascular clásicos son detectables en la infancia. La proteína C reactiva ultrasensible, la leptina y la adiponectina constituyen los factores de riesgo cardiovascular inflamatorio más importantes. Pacientes y métodos: Estudio transversal, descriptivo. Se seleccionó a alumnos de entre 6 y 12 años de dos colegios de la ciudad de Avilés. Se determinaron datos somatométricos y de prevalencia de obesidad y sobrepeso. Asimismo, se determinaron la presión arterial sistólica y diastólica y la presencia de síndrome metabólico. El nivel de ingresos familiares, los hábitos alimentarios y de estilo de vida se calcularon mediante las encuestas GRAFFAR, KIDMED y Self Report Instrument of Measuring Physical Activity, respectivamente. Analíticamente se determinaron el perfil lipídico, de insulinorresistencia, hepático, proteína C reactiva ultrasensible, leptina y adiponectina. Resultados: Se incluyó a 459 alumnos. El 31% presentaba sobrepeso y un 10,9% obesidad. Los individuos obesos presentaron valores más elevados de peso, índice de masa corporal, perímetro abdominal, presión arterial, proteína C reactiva ultrasensible y leptina, y más bajos de colesterol unido a lipoproteínas de alta densidad y apolipoproteína A que los no obesos. No se observaron diferencias en las actividades físicas y sedentarias; por el contrario, los obesos siguieron una dieta de peor calidad que los no obesos. Conclusiones: La prevalencia de obesidad y sobrepeso está alcanzando valores preocupantes en escolares. La obesidad se asocia de forma consistente a otros factores de riesgo cardiovascular clásicos y emergentes. Los escolares obesos presentan peor calidad en su alimentación aunque no realizan menos actividades físicas ni más actividades sedentarias que sus compañeros no obesos (AU)

Introduction: Classic cardiovascular risk factors are present in infancy. C-reactive protein, leptin and adiponect in are the most important inflammatory cardiovascular risk markers. Patients and methods: A descriptive, cross-sectional study, including children aged 6-12 years old from two local primary schools in the city of Avilés. Body measurements were made to determine the prevalence of obesity and overweight. Systolic and diastolic blood pressure was measured and the presence of metabolic syndrome was determined. Family income, dietary, and life-style habits were collected using the questionnaires GRAFFAR, KIDMED and Self-report instruments for measuring physical activity, respectively. Blood analysis included lipid profile, insulin resistance profile, liver profile, C-reactive protein, leptin and adiponectin. Results: A total of 459 schoolchildren were included of whom 31% were overweight and 10.9%were obese. Obese children were heavier with higher levels of body mass index, waist circumference, blood pressure, C- reactive protein, leptin, and lower levels of HDL-cholesterol and apolipoprotein A than non-obese children. No differences were found in physical and sedentary activities, but obese children had a worse quality diet than non-obese children. Conclusions: Prevalence of obesity and overweight is reaching worrying levels in school age children. Obesity is associated with other classic and inflammatory cardiovascular risk factors. Obese children have a worse quality diet, although they do not do any less physical activities or any more sedentary than non-obese children (AU)

[Classic and emergent cardiovascular risk factors in schoolchildren in Asturias]. / Factores de riesgo cardiovascular clásicos y emergentes en escolares asturianos.

INTRODUCTION: Classic cardiovascular risk factors are present in infancy. C-reactive protein, leptin and adiponectin are the most important inflammatory cardiovascular risk markers. PATIENTS AND METHODS: A descriptive, cross-sectional study, including children aged 6-12 years old from two local primary schools in the city of Avilés. Body measurements were made to determine the prevalence of obesity and overweight. Systolic and diastolic blood pressure was measured and the presence of metabolic syndrome was determined. Family income, dietary, and life-style habits were collected using the questionnaires GRAFFAR, KIDMED and Self-report instruments for measuring physical activity, respectively. Blood analysis included lipid profile, insulin resistance profile, liver profile, C-reactive protein, leptin and adiponectin. RESULTS: A total of 459 schoolchildren were included of whom 31% were overweight and 10.9% were obese. Obese children were heavier with higher levels of body mass index, waist circumference, blood pressure, C- reactive protein, leptin, and lower levels of HDL-cholesterol and apolipoprotein A than non-obese children. No differences were found in physical and sedentary activities, but obese children had a worse quality diet than non-obese children. CONCLUSIONS: Prevalence of obesity and overweight is reaching worrying levels in school age children. Obesity is associated with other classic and inflammatory cardiovascular risk factors. Obese children have a worse quality diet, although they do not do any less physical activities or any more sedentary than non-obese children.

Web 2.0 en Medicina: un conjunto de herramientas útiles y unaoportunidad de cambio / Web 2.0 in Medicine: a combination of useful tools and an opportunity for change

La evolución de la web en los últimos años ha introducido nuevos usos, al favorecer la participación y la colaboración de los usuarios para generar contenidos. Este nuevo modelo de web se ha denominado Web 2.0., y de su aplicación a la medicina ha surgido el término Medicina 2.0. En este artículo se describen varias herramientas web seleccionadas según su posible utilidad para los pediatras y por su capacidad de influir sobre la atención sanitaria, como los blogs, microblogs y wikis. Se analizan también redes sociales y servicios web que facilitan la relación entre profesionales sanitarios y usuarios, así como las comunidades de pacientes en la web. Por último, se comenta la utilidad que pueden tener la apertura de datos públicos y las aplicaciones híbridas (mashups) para la Salud Pública, y la influencia que pueden ejercer las nuevas herramientas web en la concepción de la atención sanitaria (AU)

Web evolution over past years has brought in new ways of using it, favouring user participation and collaboration to generate content. This new kind of web has been called Web 2.0, and the concept Medicine 2.0 has emerged from its application to Medicine. This article describes some web tools chosen according to their possible interest to pediatricians and to their potential to impact on health care, as blogs, micro blogging, and wikis. Social networks and other web services that facilitate integration of health care users and providers, as well as online patient communities, are also analysed. Finally, possible usefulness of Open Data and mashups for Public Health, and how new web tools may influence health care are discussed (AU)

Cinética de la proteína C reactiva y la procalcitonina en el postoperatorio de cirugía cardíaca en niños / Kinetics of C-reactive protein and procalcitonin after paediatric cardiac surgery

Introducción y objetivos: En el postoperatorio de la cirugía cardíaca se produce una respuesta inflamatoria sistémica que dificulta la identificación de complicaciones. El objetivo fue estudiar el comportamiento de la proteína C reactiva (PCR) y la procalcitonina (PCT), valorando su relación con la gravedad y analizando su utilidad para detectar complicaciones. Métodos: Se estudió prospectivamente a 59 niños intervenidos mediante cirugía cardíaca abierta. Se determinaron la PCR y la PCT al ingreso en una unidad de cuidados intensivos pediátricos, a las 24, a las 48 y a las 72h. Se analizó la relación de la PCR y la PCT con la gravedad clínica valorada mediante las escalas Pediatric Risk Mortality y Therapeutic Intervention Scoring System, y el desarrollo de complicaciones (infecciosas y hemodinámicas). Resultados: La PCR y la PCT aumentaron en las primeras 24h, disminuyendo progresivamente en los 2 días posteriores. La PCR no se relacionó con la gravedad ni con la aparición de complicaciones. La PCT tras la cirugía, a las 24 y a las 48h presentó una moderada correlación con el Pediatric Risk Mortality (r=0,548; 0,434 y 0,446, respectivamente) y una baja con el Therapeutic Intervention Scoring System. Se obtuvieron unos puntos de corte para la PCT>0,17ng/ml (sensibilidad del 73,3%, especificidad del 72,2%) al ingreso y >1,98ng/ml (sensibilidad del 57,1%, especificidad del 87%) a las 48h para detectar complicaciones. No existieron diferencias en la PCR ni en la PCT entre los pacientes con complicaciones infecciosas y hemodinámicas. Conclusiones: En el postoperatorio de la cirugía cardíaca pediátrica la PCR no se correlaciona con la gravedad ni con la presencia de complicaciones. La PCT se correlaciona con la gravedad y puede detectar complicaciones posquirúrgicas (AU)

Introduction and objectives: The systemic inflammatory response syndrome developed after cardiac surgery impedes the detection of complications. The aim of our study was to examine the behaviour of C-reactive protein (CRP) and procalcitonin (PCT), as well as to evaluate its relationship with severity and to analyse its usefulness in the identification of complications. Methods: A total of 59 children who underwent cardiac surgery with cardiopulmonary bypass were prospectively studied. CRP and PCT were determined after surgery and at 24, 48 and 72 hours. The relationships between both parameters and the clinical severity were analysed (evaluated with PRISM and TISS scoring systems), as well as with the incidence of complications (infectious and haemodynamics). Results: Serum concentrations of CRP and PCT increased in the first 24 hours after surgery, with a gradual decrease over the following days. There was no association between CRP and severity or development of complications. A moderate correlation was observed between PCT after surgery, at 24 and 48 hours, and PRISM (r=0.548; 0.434 and 0.446) and a low correlation between PCT and TISS. When studying the identification of complications, we obtained cut-off values of PCT>0.17ng/ml (Ss 73.3%; Sp 72.2%) and PCT>1.98ng/ml (Ss 57.1%; Sp 87%) immediately and 48 hours after surgery. No differences were found in CPR and PCT levels among patients with infectious and haemodynamics complications. Conclusions: CPR does not correlate with the severity or the incidence of complications after paediatric cardiac surgery. PCT correlates with clinical severity and may be able to detect post-surgical complications (AU)

[Kinetics of C-reactive protein and procalcitonin after paediatric cardiac surgery]. / Cinética de la proteína C reactiva y la procalcitonina en el postoperatorio de cirugía cardíaca en niños.

INTRODUCTION AND OBJECTIVES: The systemic inflammatory response syndrome developed after cardiac surgery impedes the detection of complications. The aim of our study was to examine the behaviour of C-reactive protein (CRP) and procalcitonin (PCT), as well as to evaluate its relationship with severity and to analyse its usefulness in the identification of complications. METHODS: A total of 59 children who underwent cardiac surgery with cardiopulmonary bypass were prospectively studied. CRP and PCT were determined after surgery and at 24, 48 and 72 hours. The relationships between both parameters and the clinical severity were analysed (evaluated with PRISM and TISS scoring systems), as well as with the incidence of complications (infectious and haemodynamics). RESULTS: Serum concentrations of CRP and PCT increased in the first 24 hours after surgery, with a gradual decrease over the following days. There was no association between CRP and severity or development of complications. A moderate correlation was observed between PCT after surgery, at 24 and 48 hours, and PRISM (r=0.548; 0.434 and 0.446) and a low correlation between PCT and TISS. When studying the identification of complications, we obtained cut-off values of PCT>0.17ng/ml (Ss 73.3%; Sp 72.2%) and PCT>1.98ng/ml (Ss 57.1%; Sp 87%) immediately and 48 hours after surgery. No differences were found in CPR and PCT levels among patients with infectious and haemodynamics complications. CONCLUSIONS: CPR does not correlate with the severity or the incidence of complications after paediatric cardiac surgery. PCT correlates with clinical severity and may be able to detect post-surgical complications.

Determinación y especiación de selenio de leche humana y en fórmulas comerciales: importancia en la nutrición del lactante / Selenium measurement and speciation in human milk and comercial formulae; importance in the nutrition of the infant

Se determina el contenido de selenio en leche humana y en fórmulas lácteas comerciales utilizando una metodología adecuada (espectrometría de masas con fuente de plasma “ICP-MS” al que se incorpora una celda de colisión para eliminar las interferencias poliatómicas “ICP-(ORC)MS”). Se comprueba que el selenio disminuye con el tiempo transcurrido desde el parto en la leche humana de madres con gestación inferior a 37 semanas y que es insuficiente para cubrir los requerimientos de este oligoelemento. Como la biodisponibilidad del selenio varía en relación a las moléculas a las que su une (especies), se utiliza una técnica híbrida (acoplamiento de una columna de cromatolografía de alta resolución “SEC” al espectrómetro de masas con fuente de plasma y celda de colisión “SEC-ICP-(ORC) MS” para conocer las especies existentes en leche humana y en fórmulas lácteas comerciales. Con esta técnica se comprueba que las distintas especies en la leche humana, no varían de forma significativa ni en relación al tiempo transcurrido desde el parto ni en relación a la duración de la gestación. Sin embargo, se encontraron diferencias significativas entre la especiación de selenio en leche de madres con parto pretérmino (antes de las 37 semanas de gestación) y en fórmulas lácteas comerciales para el recién nacido prematuro. Por último se postula la necesidad de verificar la biodisponiblidad de las diferentes especies de selenio, para así, proponer la más adecuada en la suplementación de fórmulas lácteas comerciales (AU)

The selenium content in human milk and in comercial formulae is measured using an appropriate methodology (mass spectrometry with plasma source, “ICP-MC”) to which a colision cell is added in order to eliminate polyatomic interferences “ICP-(ORC)MS”). It was verified that selenium decrease according to the time from delivery in the human milk of the mother with a pregnancy of less than 37 weeks and Is insufficient to cover the requirements of this oligoelement. As the bioavailability of selenium varies in relationship to the molecules to which it is bond (species),, a hybrid technique (high resolution chromatography column coupling “SEC” to the mass spectrometer with plasma source and collision cell “SEC-ICP-(ORC)MS”) to know the species existing in the human milk and in commercial lactic acid formulae. It ahs been verified with this technique that there is no significant variation regarding the time from delivery or the relationship to the duration of the pregnancy in the different species of human milk. However, significant differences were found between the selenium speciation in the milk of mothers having preterm delivery (before 37 weeks of pregnancy) and in commercial lactic acid formulae for the premature newborn. Finally, the need to verify the bioavailability of the different selenium species has been postulated in order to propose the most adequate in the commercial lactic acid formulae supplementation (AU)

Ascitis quilosa congénita con linfangiectasia intestinal / Congenital chylous ascitis with intestinal lymphangiectasis

Introducción. La ascitis quilosa es una entidad infrecuente que en raras ocasiones se diagnostica prenatalmente. Aunque la linfangiectasia intestinal se menciona como una de las causas de ascitis quilosa, en la práctica es difícil llegar a objetivar esta relación. Caso clínico. Se presenta el caso de un lactante diagnosticado prenatalmente de ascitis fetal e hidrocele por ecografía. Tras el parto se aprecian edemas generalizados, ascitis e hidrocele. La paracentesis muestra líquido de características quilosas. La biopsia yeyunal encuentra dilatación de los linfáticos con atrofia de vellosidades. Se instaura dieta mediante fórmula con aporte de lípidos como triglicéridos de cadena media, con lo que se consigue desaparición paulatina de la ascitis y el hidrocele. Conclusiones. Aunque lo más habitual es que se manifieste como una enteropatía con pérdida de proteínas, la linfangiectasia intestinal primaria suele considerarse parte de un trastorno que incluye todo el sistema linfático, lo cual explicaría su presentación como ascitis quilosa congénita (AU)

Chylous ascites is an infrequent entity that is rarely diagnosed in utero. Although intestinal lymphangiectasia is mentioned as one of the causes of chylous ascites, actually it is difficult to detect this relation. Clinical case. We report a case of an infant diagnosed in utero by ultrasonography of fetal ascites and hydrocele. Physical examination after birth was significant for generalized oedema, ascites, and hydrocele. Aparacentesis yielded liquid of chylous characteristics. Duodenal biopsy showed dilated lymphatics and villous atrophy. Aformula containing most lipids as medium chain triglycerides resulted in a paulatine cessation of ascites and hydrocele. Conclusions. Primary intestinal lymphangiectasia usually manifests as a protein-losing enteropathy, but it is also considered as part of a congenital disorder of the lymphatic system as a whole. This may explain its presentation as congenital chylous ascites (AU)

Internet y la información sobre la salud: información sin filtro / Internet and the information on health: unfiltered information

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Limitaciones de la procalcitonina como marcador único de sepsis neonatal de origen nosocomial / Limitations of procalcitonin as single marker of nosocomial neonatal sepsis

Introducción: Recientemente se ha sugerido que la procalcitonina (PCT) tiene capacidad discriminativa en el diagnóstico de sepsis neonatal. El objetivo de este estudio prospectivo multicéntrico es evaluar la utilidad de la PCT como marcador de sepsis neonatal de origen nosocomial. Pacientes y métodos: Se incluyeron 100 neonatos con sospecha de sepsis nosocomial de entre 4 y 28 días de vida ingresados en los servicios de neonatología de 13 hospitales de tercer nivel de España durante un período de 1 año. Se midió la concentración de PCT mediante análisis inmunoluminométrico. Se calculó la eficacia diagnóstica de la PCT en el momento de la sospecha de infección, a las 12-24 h y a las 36-48 h. Resultados: Se diagnosticaron 61 casos de sepsis nosocomial. Las concentraciones de PCT fueron superiores en los casos de sepsis nosocomial frente a los neonatos con sospecha de sepsis no confirmada. Los neonatos con sepsis por estafilococos coagulasa-negativos mostraron niveles de PCT más bajos que aquellos con sepsis nosocomial por otros agentes. Los puntos de corte óptimo para la PCT de acuerdo con las curvas ROC fueron 0,59 ng/mL en el momento de la sospecha de infección (sensibilidad 81,4%, especificidad 80,6%), 1,34 ng/mLa las 12-24 h (sensibilidad 73,7%, especificidad 80,6%) y 0,69 ng/mL a las 36-48 h (sensibilidad 86,5%, especificidad 72,7%) para el diagnóstico de sepsis de origen nosocomial. Conclusiones: La PCT mostró una moderada capacidad diagnóstica para la sepsis neonatal de origen nosocomial desde el momento de la sospecha de infección. Aunque por sí sola no sería suficientemente fiable, podría ser útil como parte de un chequeo de sepsis más completo (AU)

Background: It has recently been suggested that serum procalcitonin (PCT) is of value in the diagnosis of neonatal sepsis, with varying results. The aim of this prospective multicenter study was to assess the usefulness of PCT as a marker of neonatal sepsis of nosocomial origin. Methods: One hundred infants aged between 4 and 28 days of life admitted to the Neonatology Services of 13 acutecare teaching hospitals in Spain over 1-year with clinical suspicion of neonatal sepsis of nosocomial origin were included in the study. Serum PCT concentrations were determined by a specific immunoluminometric assay. The reliability of PCT for the diagnosis of nosocomial neonatal sepsis at the time of suspicion of infection and at 12-24 h and 36-48 h after the onset of symptoms was calculated. Results: The diagnosis of nosocomial sepsis was confirmed in 61 neonates. Serum PCT concentrations were significantly higher at initial suspicion and at 12–24 h and 36- 48 h after the onset of symptoms in neonates with confirmed sepsis than in neonates with clinically suspected but not confirmed sepsis. Optimal PCT thresholds according to ROC curves were 0,59 ng/mL at the time of suspicion of sepsis (sensitivity 81,4%, specificity 80,6%); 1,34 ng/mL within 12-24 h of birth (sensitivity 73,7%, specificity 80,6%), and 0,69 ng/mL within 36-48 h of birth (sensitivity 86,5%, specificity 72,7%). Conclusions: Serum PCT concentrations showed a moderate diagnostic reliability for the detection of nosocomial neonatal sepsis from the time of suspicion of infection. PCT is not sufficiently reliable to be the sole marker of sepsis, but would be useful as part of a full sepsis evaluation (AU)

Definiciones de sepsis neonatal: un largo camino por recorrer / Definitions of neonatal sepsis: a long way to go

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[Procalcitonin for the diagnosis of neonatal sepsis of vertical transmission]. / Procalcitonina para el diagnóstico de sepsis neonatal de transmisión vertical.

OBJECTIVE: To evaluate procalcitonin (PCT) as a diagnostic marker of neonatal sepsis of vertical transmission and to compare the results of PCT with those of the most widely used laboratory tests for sepsis. PATIENTS AND METHODS: A prospective study was conducted in 136 blood samples from 69 newborn infants admitted to a neonatal department. PCT, C-reactive protein (CRP), leukocyte count, and the immature-to-total neutrophil ratio (I/T ratio) were measured. The PCT reference range of controls from 0 to 72 hours of life was constructed, and the diagnostic efficiency of the tests was calculated, with their 95 % confidence intervals (95 % CI). RESULTS: This study included 35 controls, 24 neonates with noninfectious disorders, and 10 neonates with sepsis (5 with culture-proven sepsis). PCT, CRP, and the I/T ratio discriminated septic from nonseptic patients. Their areas under the ROC curve were 0.696 (p = 0.009), 0.735 (p = 0.002), and 0.703 (p = 0.006), respectively, with no statistically significant differences. The accuracy of PCT, CRP, and leukocyte count improved after 24 hours of life with areas under the ROC curve of 0.813 (p = 0.007), 0.826 (p = 0.005), and 0.841 (p = 0.003), respectively. Overall, PCT detected vertically transmitted sepsis with a sensitivity of 68.4 % (95 % CI: 46.0 %-84.6 %), specificity of 82.4 % (95 % CI: 72.2 %-89.4 %), positive likelihood ratio of 3.89 (95 % CI: 2.18 %-6.96 %), and negative likelihood ratio of 0.38 (95 % CI: 0.19 %-0.76 %), similar to those of CRP. CONCLUSIONS: PCT may be a useful marker for the diagnosis of vertically transmitted sepsis. Studies with larger sample sizes are required to establish the accuracy of PCT.

[Procalcitonin for the diagnosis of nosocomial neonatal sepsis]. / Procalcitonina para el diagnóstico de sepsis neonatal de origen nosocomial.

BACKGROUND: Nosocomial sepsis is a major problem in neonatal units. Because the clinical signs are nonspecific, highly reliable diagnostic markers are required to guide diagnosis. The aim of this study was to evaluate the utility of procalcitonin (PCT) as a diagnostic marker for nosocomial neonatal sepsis, and to compare the results of PCT with those of the most widely used laboratory tests for sepsis. PATIENTS AND METHODS: Twenty neonates with nosocomial sepsis and 20 controls aged 4-30 days were included in a prospective study performed in a neonatal intensive care unit. PCT, C-reactive protein (CRP), leukocyte count, and the immature-to-total neutrophil ratio (I/T ratio) were measured at onset of signs of infection. The sensitivity, specificity, and likelihood ratio for a positive (LR+) and a negative (LR-) result were calculated. RESULTS: PCT, CRP, and the I/T ratio discriminated septic from nonseptic patients. Their areas under the ROC curve were 0.849, 0.880, and 0.884, respectively, with no statistically significant differences. Optimal cut-off values were: PCT > or = 0.65 ng/ml (sensitivity 85 %, specificity 80 %, LR 1 4.25, LR- 0.19), PCR > or = 5 .g/ml (sensitivity 80 %, specificity 95 %, LR 1 16, LR- 0.21), and I/T > or = 0.03 (sensitivity 90 %, specificity 75 %, LR 1 3.6, LR- 0.13). CONCLUSIONS: PCT may be a useful marker for the diagnosis of nosocomial neonatal sepsis. Studies with larger samples are required to compare the accuracy of PCT with that of other markers of sepsis.