Nutrition supplementation plus standard of care versus standard of care alone or standard of care plus unconditional cash transfer in the prevention of chronic malnutrition in Southern Angola: study protocol for the MuCCUA study, a cluster randomized controlled trial.

BACKGROUND: Chronic malnutrition is a condition associated with negative impacts on physical and cognitive development. It is multi-causal and can start very early in life, already in utero, thus it is especially challenging to find appropriate interventions to tackle it. The government of Angola is implementing a standard of care program with potential to prevent it, and the provision of cash transfers and the supplementation with small quantity lipid-based nutrients (SQ-LNS) are also promising interventions. We aimed to evaluate the impact of the standard of care program alone and of the standard of care plus a cash transfer intervention in the lineal growth of children less than 2 years old and compare it to the effectiveness of a nutrition supplementation plus standard of care program in Southern Angola. METHODS/DESIGN: The three-arm parallel cluster randomised controlled trial is set in four communes of Huila and Cunene provinces. Clusters are villages or neighbourhoods with a population around 1075 people. A total of twelve clusters were selected per arm and forty pregnant women are expected to be recruited in each cluster. Pregnant women receive the standard of care alone, or the standard of care plus unconditional cash transfer or plus nutritional supplementation during the first 1000 days, from pregnancy to the child reaching 24 months. The primary outcome is the prevalence of stunting measured as height-for-age Z-score (HAZ) < -2 in children below 2 years. Impact will be assessed at 3, 6, 12, 18 and 24 months of children's age. Secondary outcomes include mortality, morbidity, caring, hygiene and nutrition behaviours and practices, and women and children's dietary diversity. Quantitative data are also collected on women's empowerment, household food security, expenditure and relevant clinical and social events at baseline, endline and intermediate time points. DISCUSSION: The results will provide valuable information on the impact of the standard of care intervention alone as well as combined with an unconditional cash transfer intervention compared to a nutrition supplementation plus standard of care intervention, carried out during the first 1000 days, in the children´s growth up to 2 years and related outcomes in Southern Angola. TRIAL REGISTRATION: Clinical Trials NCT05571280. Registered 7 October 2022.

Fiebre-fobia nosocomial: un miedo contagioso / Nosocomial fever phobia: an infectious fear

Introducción: En 1980, Schmitt introdujo el término «fiebre-fobia» para referirse al miedo injustificado que los padres presentaban ante la fiebre de los niños. Más de 35 años después, el temor infundado persiste. El objetivo principal de este trabajo era realizar una encuesta a los trabajadores de cuatro hospitales públicos y analizar el grado de conocimiento sobre la fiebre en niños. Pacientes y métodos: Estudio descriptivo, transversal y multicéntrico. Se enviaron 4.830 encuestas anónimas por correo electrónico a los participantes, entre el 15 de septiembre y el 15 de octubre de 2015. Se llevó a cabo un análisis estadístico mediante el programa SPSS v22.0. Se estimó como suficiente un tamaño muestral de 450 respuestas, con un error <4,4% y un intervalo de confianza del 95% (heterogeneidad del 50%). Resultados: Se obtuvieron 462 respuestas de los participantes. Un 75% eran mujeres, un 56% tenían menos de 35 años, un 81% eran profesionales sanitarios y un 60% tenían hijos. Respecto al conocimiento sobre la fiebre, un 83% cree que deben usarse las medidas físicas (no recomendado), un 60% piensa que el tratamiento precoz previene las convulsiones (falso), un 56% considera que siempre se debe tratar aunque el niño se encuentre bien (erróneo) y un 41% cree que se deben combinar antitérmicos (incorrecto). Un 86% de los encuestados reconoce que la fiebre-fobia existe. Hay diferencias significativas en los resultados entre sanitarios y no sanitarios, entre encuestados con hijos y sin hijos, e incluso entre sexos. Conclusiones: Un importante porcentaje de los trabajadores hospitalarios, médicos y pediatras incluidos, desconocen las actuales recomendaciones sobre la fiebre en niños. Este desconocimiento favorece la persistencia de la fiebre-fobia, un miedo contagioso que da lugar a tratamientos innecesarios. Se requiere una adecuada transmisión de la información a las familias, pero cualquier esfuerzo será ímprobo mientras los sanitarios no nos creamos nuestras propias recomendaciones (AU)

Introduction: In 1980, Schmitt was the first to coin the term "fever phobia" to describe parents’ unrealistic fears about fever. More than 35 years later, this unfounded fear remains. A survey is conducted in Spain to the workers of four public hospitals. Knowledge about fever in children is analyzed, being the main aim of the study. Patients and methods: A descriptive, cross-sectional and multicenter study was conducted from 15th September 2015 to 15th October 2015. 4,830 anonymous surveys were sent by e-mail. A sample size of 450 replies was estimated as sufficient, with a miscalculation <4.4% and a confidence interval of 95% (50% heterogeneity). SPSS v22.0 was used for statistical data analysis. Results: Out of 462 responses were received. Seventy five per cent were women, 56% were under 35 years old, 81% were healthcare professionals and 60% were parents. Results concerning fever knowledge were: 83% affirm that physical methods should be used (not recommended), 60% think that seizures could be prevented with early treatment of fever (false), 56% support that fever should always be treated, even if the child is healthy (wrong) and 41% encourage that antipyretics should be alternated (incorrect). Eighty six per cent of the workers recognized that the fever phobia exists. There are significant differences in responses depending on healthcare and non-healthcare professionals, on being parents or not, and even on gender. Conclusions: A significant percentage of hospital workers, including doctors and pediatricians, are unaware of the existing recommendations on fever in children. This ignorance favors the persistence of fever-phobia, an infectious fear that leads to unnecessary treatments. Adequate transmission of information to families is needed, but every effort will be arduous while healthcare professionals do not believe their own recommendations (AU)

Imported malaria in children in Madrid, Spain, 2007-2013 / Malaria importada en niños en la Comunidad de Madrid, 2007-2013

Background: The majority of malaria cases diagnosed in Europe in the last few years have occurred in people living in non-endemic areas travelling back to their home country to visit friends and relatives (VFRs). Children account for 15-20% of imported malaria, with known higher risk of severe disease. Material and methods: A retrospective multicentre study was conducted in 24 hospitals in Madrid (Spain) including patients under 16 years diagnosed with malaria (2007-2013). Results: A total of 149 episodes in 147 children were reported. Plasmodium falciparum was the species most commonly isolated. Twenty-five patients developed severe malaria and there was one death related to malaria. VFR accounted for 45.8% of our children. Only 17 VFRs had received prophylaxis, and 4 of them taken appropriately. They presented more frequently with fever (98% vs. 69%), a longer time with fever (55 vs. 26%), delay in diagnosis of more than three days (62 vs. 37%), and more thrombocytopenia (65 vs. 33%) than non-VFRs, and with significant differences (p < 0.05). Conclusions: VFRs represent a large proportion of imported malaria cases in our study. They seldom took adequate prophylaxis, and delayed the visit to the physician, increasing the length of fever and subsequent delaying in diagnosis. Appropriate preventive measures, such as education and pre-travel advices should be taken in this population (AU)

Antecedentes: En los últimos años la mayoría de los casos de malaria en Europa se han producido en personas asentadas en zonas no endémicas que viajan a su país de origen para visitar a amigos y familiares (VFR). Los niños representan el 15-20% de la malaria importada, con el conocido alto riesgo de enfermedad grave. Material y métodos: Estudio multicéntrico retrospectivo en 24 hospitales en Madrid, que incluyó pacientes menores de 16 años con diagnóstico de malaria (2007-2013). Resultados: Se registraron 149 episodios en 147 niños. Plasmodium falciparum fue la especie más frecuentemente aislada. Veinticinco niños padecieron paludismo grave y hubo una muerte relacionada con la malaria. Los pacientes VFR representaron el 45,8% de nuestros niños estudiados. Solo 17 de los VFR habían recibido profilaxis y en solo 4 casos la tomaron apropiadamente. Estos pacientes presentaron con más frecuencia fiebre (98% vs 69%), retraso en el diagnóstico más de 3 días (62 vs 37%) y trombocitopenia (65 vs 33%). Conclusiones: Los niños VFR representaron una gran proporción de casos de paludismo importado en nuestro estudio. Rara vez tomaron la profilaxis de forma adecuada. Además estos niños presentaron un mayor retraso en la consulta al médico tras la aparición de síntomas, con el subsiguiente retraso en el diagnóstico. Es necesario tomar las medidas preventivas adecuadas, como la educación o el consejo pre-viaje, en esta población (AU)

Hiperfrecuentadores en Urgencias Pediátricas: ¿es toda la culpa de los padres? / Frequent users in Pediatric Emergency Departments, it is all the parents' fault?

Introducción: existe poca información sobre el abuso de las Urgencias Pediátricas. El objetivo principal es determinar el perfil de los padres hiperfrecuentadores en un hospital de media complejidad y estimar el grado de preocupación de los padres según respuestas a una encuesta telefónica. Pacientes y métodos: estudio descriptivo, transversal y unicéntrico. Se realiza un análisis retrospectivo de los informes de alta en niños ≤ 14 años con ≥ 10 consultas en Urgencias Pediátricas en el periodo desde el 1 de enero al 31 de diciembre de 2015. A través de entrevista telefónica, se preguntó a los padres si acudirían o no a Urgencias ante 25 supuestos clínicos. Análisis de datos mediante SPSS(R) v22.0. Resultados: 21 niños realizaron ≥ 10 consultas, que suponen 246 episodios (1,17% del total de Urgencias). Edad mediana de 1,5 años; 52,2% varones. La relación entre el número de consultas en el centro de salud frente a Urgencias Pediátricas fue < 1 en el 38%. Solo nueve de 246 (3,65%) precisaron ingreso. Solo en 74 (30,1%) fue necesaria una atención que no hubiera podido ser solucionada en Atención Primaria. Se observa una relación entre los motivos de consulta y los antecedentes personales. Conclusiones: determinar qué pacientes son hiperfrecuentadores es una tarea fácil. Contactar con los padres de estos niños y ofrecer consultas de educación sanitaria constituye una opción plausible y eficiente, que contaría con aceptación por parte de la población, mejoraría la calidad percibida y podría ahorrar costes al Sistema Nacional de Salud. Este tipo de consultas informativas constituyen parte de un proyecto que se implementará en nuestro hospital en 2017 (AU)

Introduction: there is little information regarding the abuse of consultations in the Pediatric Emergency Departments (PED). The aims of the study are to determine the characteristics of frequent users in a public general hospital, and to estimate the concerns of parents guided by responses to a telephone survey. Patients and methods: a descriptive, cross-sectional, unicentric and local study was conducted from January to December 2015. All children ≤ 14 years visiting Pediatric Emergency Departments ≥ 10 times were included. Through a telephone interview, parents were asked whether or not they would go to the Emergency Room for 25 supposed clinical cases. SPSS v22.0(R) was used for statistical analysis. Results: 21 children (52.2% males) visited PED ≥ 10 times, involving 246 clinical cases (1.17% of total emergencies). Median age was 1.5 years. The ratio of the number of visits at Primary Care vs. PED' was < 1 in 38%. Admission was required only in 9 of 246 (3.65%) children. Visits that could not be solved at Primary Care were observed only in 74 cases (30.1%). Reasons for a pediatric visit and personal history were related. Conclusions: to determine which patients are frequent users is an easy task. To contact the parents of these children and to provide health education could be a feasible and efficient chance, which would be accepted by the population, it also would improve the perceived quality and could save costs to the National Health System. This kind of visits promoting health education are part of a project which will be implemented in our hospital in 2017 (AU)

Afectación articular en la púrpura de Schönlein-Henoch: revisión a propósito de un caso / Joint disease and Schönlein-Henoch Purpura: a case review

La púrpura de Schönlein-Henoch es el tipo de vasculitis más común en la infancia. Sus manifestaciones clínicas más frecuentes son: púrpura palpable, artralgias, dolor abdominal, sangrado intestinal y nefritis, aunque cualquier órgano puede verse afectado. Un gran número de estudios concluye que la IgA tiene un gran papel en su patogénesis. Es más prevalente en el sexo masculino y la media de aparición es a los 6-7 años. Los síntomas articulares son la segunda manifestación más frecuente, tras de la púrpura palpable. La afectación articular se produce en el 40-82% de pacientes, siendo más frecuente en menores de siete años. Esta puede ser el síntoma de presentación en el 15-43% de los casos. Las manifestaciones articulares incluyen artritis y artralgias. La afectación suele ser oligoarticular. El dolor es migratorio y recurrente. Las articulaciones más implicadas son rodillas, tobillos y caderas. El diagnóstico es clínico y el manejo terapéutico conservador, con antiinflamatorios no esteroides en un escalón inicial. Los corticoides se reservan para aquellos casos con dolor intratable. La artralgia-artritis es transitoria y se resuelve en pocos días sin dejar secuelas. La tasa de recurrencia de la afectación articular es muy baja (AU)

Schönlein-Henoch purpura is the most common type of vasculitis in childhood. Its most frequent clinical manifestations are: palpable purpura, arthritis, abdominal pain, intestinal bleeding and nephritis although any organ may be affected. A large number of studies conclude that IgA plays a large role in its pathogenesis. It is more prevalent in males and the mean age of onset is at 6-7 years. Joint symptoms are the second most frequent manifestation, after palpable purpura. Joint involvement occurs in 40-82% of patients, being more frequent in children under 7 years. This may be the presenting symptom in 15-43%. Joint manifestations include arthritis and arthralgia. The affectation is usually oligoarticular. Pain is migratory and recurrent. The most involved joints are knees, ankles, feet and hips. The diagnosis is clinical and the therapeutic management is conservative, with nonsteroidal anti-inflammatory drugs at an early stage, requiring only corticosteroids if pain is intractable. Arthralgia-arthritis is transient and resolves within a few days without consequences. The recurrence rate of joint involvement is very low (AU)

Imported malaria in children in Madrid, Spain, 2007-2013.

BACKGROUND: The majority of malaria cases diagnosed in Europe in the last few years have occurred in people living in non-endemic areas travelling back to their home country to visit friends and relatives (VFRs). Children account for 15-20% of imported malaria, with known higher risk of severe disease. MATERIAL AND METHODS: A retrospective multicentre study was conducted in 24 hospitals in Madrid (Spain) including patients under 16 years diagnosed with malaria (2007-2013). RESULTS: A total of 149 episodes in 147 children were reported. Plasmodium falciparum was the species most commonly isolated. Twenty-five patients developed severe malaria and there was one death related to malaria. VFR accounted for 45.8% of our children. Only 17 VFRs had received prophylaxis, and 4 of them taken appropriately. They presented more frequently with fever (98% vs. 69%), a longer time with fever (55 vs. 26%), delay in diagnosis of more than three days (62 vs. 37%), and more thrombocytopenia (65 vs. 33%) than non-VFRs, and with significant differences (p<0.05). CONCLUSIONS: VFRs represent a large proportion of imported malaria cases in our study. They seldom took adequate prophylaxis, and delayed the visit to the physician, increasing the length of fever and subsequent delaying in diagnosis. Appropriate preventive measures, such as education and pre-travel advices should be taken in this population.

Adecuación del diagnóstico y tratamiento de la faringoamigdalitis aguda a las guías actuales / Appropriateness of diagnosis and treatment of acute pharyngotonsillitis to current guidelines

Introducción: la faringoamigdalitis aguda (FAA) es una de las enfermedades más comunes en la infancia. El manejo diagnóstico y terapéutico es sencillo y, desde 2011, está consensuado. El objetivo principal es analizar la adecuación al consenso en un hospital de media complejidad, donde trabaja uno de los autores de dicho documento de consenso. Pacientes y métodos: estudio descriptivo, transversal, unicéntrico y de ámbito local. Se realiza un análisis retrospectivo de los informes de alta y pruebas complementarias en todos los niños ≤ 14 años diagnosticados de FAA en Urgencias Pediátricas. Periodo: del 1 de enero al 31 de diciembre de 2015. Resultados: se analizan 176 FAA (el 52,3%, niñas). La valoración clínica se realiza siempre mediante la escala de McIsaac. El 46,5% recibieron antibióticos antes de la realización de una técnica de detección rápida de antígeno estreptocócico o cultivo, en todos ellos. El 100% de los antibióticos y dosis prescritas se ajustaron al consenso. Los intervalos de dosis y la duración del tratamiento fueron adecuados en > 85% de los casos. Las prescripciones inadecuadas fueron pautadas por solo dos de los 17 pediatras del hospital. Conclusiones: la adecuación es superior a lo descrito en otras series. El uso apropiado de antibióticos puede mejorar mediante la formación continuada y regular por parte de pediatras especializados en enfermedades infecciosas. Además, se sugiere que los tratamientos inadecuados se analicen según prescriptor, para seleccionar qué facultativos deben recibir una formación específica. Es prioritario adecuar la prescripción de antimicrobianos en la FAA a la evidencia científica en nuestro país (AU)

Introduction: acute tonsillopharyngitis (ATP) is one of the most common childhood diseases. The diagnosis and therapeutic management is simple. Further, a consensus document exists in Spain since 2011. The aim of this study is to analyze the appropriateness to consensus in a general hospital, where an author of the consensus document is working. Patients and methods: a descriptive, cross-sectional, single-center and local study was conducted from January to December 2015. All children ≤ 14 years diagnosed as ATP in the Pediatric Emergency room were included. Clinical records and complementary tools were retrospectively studied. Results: a total of 176 ATP were analyzed (52.3% girls). Clinical assessment was always performed by McIsaac score. After conducting culture or a rapid antigen-detection test, 46.5% of children received antibiotics. Selection of antimicrobials and prescribed doses were 100% adjusted to consensus. Dose ranges and duration of treatment were >85% appropriated. Only two of 17 pediatricians working on the hospital were responsible of inappropriate prescriptions. Conclusions: appropriateness is higher than reported in other studies. Rational use of antibiotics could be improved through continuous and regular training by experts in pediatric infectious diseases. In addition, it is suggested to analyze inappropriate prescribers to select pediatricians that should receive specific training. In Spain, it is of primordial importance to adapt the prescribing of antibiotics to the scientific evidence (AU)

Evaluation of clinicians' knowledge and practices regarding medical radiological exposure: findings from a mixed-methods investigation (survey and qualitative study).

OBJECTIVES: To assess the impact of initiatives aiming to increase clinician awareness of radiation exposure; to explore the challenges they face when communicating with patients; to study what they think is the most appropriate way of communicating the long-term potential risks of medical radiological exposure to patients. DESIGN: A quantitative and qualitative evaluation through a survey and focal groups. SETTING: San Juan Hospital and Dr Peset Hospital (Southeast Spain) and clinicians from Spanish scientific societies. PARTICIPANTS: The surveys were answered (a) in person (216: all the radiologists (30), urologists (14) and surgeons (44) working at both participant hospitals; a sample of general practitioners from the catchment area of one hospital (45), and a consecutive sample of radiologists attending a scientific meeting (60)) or (b) electronically through Spanish scientific societies (299: radiologists (45), pneumologists (123), haematologists (75) and surgeons (40)). Clinicians were not randomly selected and thus the results are limited by the diligence of the individuals filling out the survey. PRIMARY AND SECONDARY OUTCOME MEASURES: Clinicians' knowledge and practices regarding medical radiological exposure, and what they considered most appropriate for communicating information to patients. RESULTS: Nearly 80% of the clinicians surveyed had never heard of the European recommendations. Fewer than 20% of the clinicians surveyed identified correctly the radiation equivalence dose of intravenous urography or barium enema. It was reported by 31.7% that they inform patients about the long-term potential risks of ionising radiation. All participants agreed that the most appropriate way to present information is a table with a list of imaging tests and their corresponding radiation equivalence dose in terms of chest X-rays and background radiation exposure. CONCLUSIONS: Medical radiological exposure is frequently underestimated and rarely explained to patients. With a clear understanding of medical radiological exposure and proper communication tools, clinicians will be able to accurately inform patients.

Evaluation of the environmental plasticity in the xerohalophyte Zygophyllum fabago L. for the phytomanagement of mine tailings in semiarid areas.

Phytomanagement by phytostabilisation of metal(loid)-enriched mine tailings in semiarid areas has been proposed as a suitable technique to promote a self-sustainable vegetal cover for decreasing the spread of polluted particles by erosion. The goal of this work was to evaluate the contribution of a pioneer plant species (Zygophyllum fabago) in ameliorating the soil conditions at two mine tailings piles located in a semiarid area in Southeast Spain. The ecophysiological performance of this plant species compared to a control population was assessed by analysing the nutritional and ecophysiological status. The presence of Z. fabago in mine tailings enhanced the soil microbial activity and increased the content of soil organic carbon within the rhizosphere (approx. 50% increasing). Metal(loid) concentrations in the tailings may play a minor role in the establishment of Z. fabago plants due to the low metal(loid) availability in the tailings (low CaCl2-extractable concentrations) and low uptake in the plants (e.g. up to 300 mg kg(-1) Zn in leaves). The lower δ13C and δ18O in the plants sampled at both tailings compared to the control ones may indicate softer stomatal regulation in relation to the control site plants and therefore lower WUE [corrected]. The Z. fabago plants may skip some energy-demanding mechanisms such as stomatal control and/or proline synthesis to overcome the environmental stresses posed at the tailings. The Z. fabago plants revealed high plasticity of the species for adapting to the low fertility soil conditions of the tailings and to overcome constraints associated to the dry season.

Servicios no presenciales: nuevas luces en el quehacer de siempre / No disponible

No disponible

Manejo práctico de mordeduras en Atención Primaria y en nuestro medio / Animal bites in Spain. Pediatric guideline for Primary Care

Se estima que las mordeduras de animales representan aproximadamente el 1% de las consultas pediátricas urgentes. El miedo popular, sobre todo a la temida rabia, sumado a la presencia de una aparatosa herida, hace que la consulta genere una importante preocupación en los padres. Sin embargo, cuando se trata de una mordedura de serpiente, no es raro que los padres estén tranquilos y sea el pediatra el que muestre preocupación. Se presenta una revisión sobre el tema con el objetivo principal de recomendar una actitud general para tratar las mordeduras en niños. Se realizan además una serie de apreciaciones sobre algunos casos en particular, como por ejemplo las mordeduras de serpiente, siempre valorando las posibilidades reales en territorio español, sin considerar animales tropicales o exóticos. También se aborda en un apartado especial el riesgo de transmisión de la rabia en nuestro medio (AU)

It is estimated that animal bites account for about 1% of pediatric emergency department visits. The popular fear, especially the dreaded rabies, coupled with the presence of a large wound, usually causes fear in parents. However, when the bite comes from a snake, it is not uncommon that parents feel relaxed, whereas the one who is concerned is the pediatrician. A review of the subject is presented with the aim of recommending a general attitude to treat animal bites in children. Several comments about some particular cases are also described, such as snake bites, always considering the real possibilities in the Spanish territory, regardless tropical or exotic animals. The risk of rabies transmission in our country is also covered in this document (AU)

Edema agudo hemorrágico en un neonato / Acute hemorrhagic edema in a newborn

El edema agudo hemorrágico del lactante (EAHL) es una enfermedad infrecuente de curso benigno, de aparición entre los tres meses y los dos años de edad. De forma excepcional debuta en el periodo neonatal. Se caracteriza por la aparición de lesiones cutáneas eritematosas y purpúricas de predominio en miembros inferiores y región facial, que tienden a la resolución espontánea en días o semanas. Presentamos el caso de un edema agudo hemorrágico de aparición neonatal en una niña de 17 días de vida, valorada en nuestro servicio (AU)

Acute hemorrhagic edema of infancy is an infrequent disease with a benign course that appears between 3 months and 2 years old and, exceptionally, during the neonatal period. It is characterized by erythematous edema and purpuric lesions involving mainly the face and extremities, with a spontaneous recovery in days to weeks. We report a case of acute hemorrhagic edema with a neonatal onset in a 17 days-old girl, followed in our service recently (AU)

Calcificación hepática congénita: ¿preocuparse o no preocuparse? Esa es la cuestión / Congenital liver calcification. Shall we worry or not? That is the question

Las calcificaciones hepáticas fetales son un hallazgo relativamente frecuente. Pueden ser superficiales o intrahepáticas. Su presencia se ha relacionado con múltiples patologías (peritonitis meconial, infecciones connatales, cromosomopatías, isquemia, tumores, etc.). A pesar de su alta frecuencia, su manejo no está debidamente protocolizado. Presentamos un caso de calcificación hepática diagnosticada en la semana 24 de embarazo, confirmada posnatalmente y de evolución favorable (AU)

Fetal liver calcifications are a relatively common finding. They may be superficial or intrahepatic. Their presence has been linked to many diseases (meconium peritonitis, connatal infections, chromosomal abnormalities, ischemia, tumors, etc.). Despite its high frequency, their management is not properly notarized. We introduce a case of liver calcification diagnosed at 24th pregnancy week and postnatally confirmed (AU)

Manejo práctico de las picaduras de insecto en Atención Primaria / Insect bites in Spain. Pediatric guideline for Primary Care

Las picaduras de insecto constituyen un motivo habitual de consulta en Atención Primaria. Existen suficientes guías clínicas pediátricas y protocolos para atender de forma apropiada a los niños. Sin embargo, se trata de situaciones clínicas muy influenciadas por la tradición popular. Esto, en ocasiones, puede incluso alterar la actuación del pediatra, si se deja guiar por costumbres, prácticas y tratamientos basados en divulgación no científica. Se presenta una revisión sobre el tema con el objetivo principal de recomendar una actitud general para tratar las picaduras de insecto en niños. Se realizan además una serie de apreciaciones sobre algunos casos en particular, como por ejemplo arañas, escorpiones y garrapatas, siempre valorando las posibilidades reales en territorio español, sin considerar insectos tropicales o exóticos. También se abordan medidas preventivas frente a las picaduras y aspectos relativos a fenómenos alérgicos (AU)

Insect bites are a common reason for consultation in primary care. There are enough pediatric guidelines and protocols for treating children appropriately. However, stings are heavily influenced by lore. Because of this, pediatricians could change their performance sometimes, mainly if they are guided by customs and practices based on unscientific treatments. A review on the subject is presented with the aim of recommending a general attitude to treat insect bites in children. Several comments about some particular cases are also carried, such as spiders, scorpions and ticks, always taking into account the real possibilities in the Spanish territory, regardless of tropical or exotic insects. Preventive measures against stings and hypersensitivity phenomena are also covered in this document (AU)

Prevalence and variables associated with solitary pulmonary nodules in a routine clinic-based population: a cross-sectional study.

OBJECTIVE: To determine the prevalence of solitary pulmonary nodules (SPNs) in chest radiology studies and patient's features associated with malignancy in a non-high-risk clinical population. METHODS: Patients ≥35 years were referred for thoracic imaging in two hospitals (2010-2011). Eight radiologists determined the presence and characteristics of SPN. Selected variables were collected from radiological register and medical records. Observer agreement in the diagnosis of SPN was assessed. RESULTS: 25,529 patients were included: 23,102 (90.5%) underwent chest radiograph and 2,497 (9.5%) a CT. The prevalence of SPN was 2.1% (95% CI 1.9 - 2.3) in radiographs and 17.0% (95% CI 15.5 - 18.5) in CT. In patients undergoing chest radiograph, detection of SPN with an irregular border was more frequent among smokers. In patients who had a CT, larger SPNs appeared to be associated with 60 years of age or over, diagnosis of a respiratory illness, or male gender. In addition, an irregular border was also more common among men. CONCLUSIONS: The prevalence of SPNs detected by both radiograph and CT was lower than that shown in screening studies. Patient characteristics such as age, sex, respiratory disease, or smoking habit were associated with nodule characteristics that are known to be related with malignancy. KEY POINTS: There is a lower SPN prevalence in the clinical population than in screening studies. SPN prevalence is associated with some patient characteristics: sex, age, imaging test. Nodule characteristics related to malignancy were associated with some patient characteristics.

Hábitos de merienda en escolares de nuestro medio. Estudio HABIMER Plus / Afternoon snack habits amongst schoolchildren in our society. HABIMER Plus Study

Introducción: los hábitos alimentarios adquiridos en la edad escolar son el molde que se reproducirá en la edad adulta. La merienda debe constituir el 15-20% de las calorías diarias, y es una buena oportunidad para administrar frutas, lácteos y cereales. Objetivo: conocer los hábitos alimentarios en la merienda de niños escolares entre 6 y 12 años. Material y métodos: evaluación de los hábitos de merienda de los niños de 6-12 años en un colegio de la Comunidad Autónoma de Madrid. Se realizó una encuesta a los niños sobre los hábitos en la merienda de los tres últimos días. Los resultados se analizaron en el programa SPSS®. Resultados: se analizaron 214 encuestas, 104 pertenecientes a niñas y 107 a niños. El 76% de los niños merienda todos los días. Este porcentaje disminuye hasta un 28 y un 20% en los niños de 11 y 12 años, respectivamente. El 60-69% refiere comer un bocadillo o sándwich; un 49%, fruta, y un 38,5%, bollería industrial. En cuanto a los lácteos, el 94% ingiere algún tipo de lácteo; sin embargo, el 76% lo había ingerido en forma de batidos, natillas o flanes. El 48% de los niños acompañó con agua su merienda, mientras que el 70,1% lo hizo con zumos envasados. Conclusiones: hay que hacer hincapié en los alimentos ofertados en la merienda, estableciendo medidas orientadas a recomendar más frutas frescas en lugar de zumos envasados, de lácteos en forma de leche/yogur en lugar de batidos y flanes, y evitar el consumo de bollería (AU)

Introduction: dietary habits acquired at school age are the cast to be played in adulthood. The afternoon snack should provide 15-20% of daily calories and it's a good opportunity to manage fruit, milk and cereals. Objective: to know the afternoon snack habits in schoolchildren between 6 and 12 years old. Methods: assessment of afternoon snack habits in children aged 6-12 years old in a school in Madrid. A survey on afternoon snack habits in the last 3 days was conducted to children. The results were analyzed in SPSS(R). Results: a total of 214 surveys were analyzed, 104 girls and 107 boys. Children having an afternoon snack every day were 76%, decreasing to 28 to 20% in children aged 11 and 12 years old respectively. It consisted of bread or sandwich in 60-69%, fruit 49% and industrial bakery 38.5%. As for milk, 94% had some type of dairy product; however 76% had it in the form of shakes, custards or puddings. A rate of 48% of children drink water, while 70.1% drink packaged juices. Conclusions: measures to establish a change in the type of snack seem necessary, recommending the consumption of fresh fruit instead of packaged juices, milk or yoghurt instead of shakes, custards and puddings, and avoiding the consumption of pastries

Sistemas de ventilación no invasiva de alto flujo en neonatología: revisión y aproximación a su utilización en hospitales de la Comunidad de Madrid / High flow non-invasive ventilation systems: review and approximation to its use in hospitals throughout Madrid

El uso de sistemas de ventilación de alto flujo ha ido creciendo en el ámbito de la neonatología en los últimos años. Estos dispositivos difieren de los sistemas de ventilación de presión continua (CPAP), por ejemplo, en la necesidad de que exista una fuga pericánula variable, y no deben emplearse como sustitutos de la CPAP. Es fundamental garantizar un adecuado calentamiento y humidificación del flujo para su correcta utilización. Sin embargo, a pesar de los numerosos estudios que intentan demostrar su eficacia y seguridad, y de la impresión subjetiva de ser un buen método de oxigenoterapia no invasiva, tanto en niños nacidos a término como en prematuros, aún desconocemos la presión espiratoria final exacta que generan en la orofaringe, y en qué patologías deben emplearse; por tanto, de momento no se pueden establecer protocolos de uso estandarizados (AU)

There is an increasing use of heated and humidified high flow ventilation systems in neonatology. There are some clear differences with continued airway pressure ventilation systems, such as the need for a variable nose leak. Heated and humidified airflow is imperative for its correct use. Despite a wide number of studies attempting to demonstrate its safety and effectiveness, and the general impression that it is a valid mode of oxygen therapy, both in preterm and term babies, we still do not know precisely what end expiratory pressure is being generated or in what scenarios to use it, therefore no standardized protocols for its use have currently been established (AU)

Delirium prolongado por propofol en un adolescente de 14 años / Prolonged delirium due to propofol sedation in an adolescent

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Piomiositis por Moraxella osloensis / Pyomyositis due to Moraxella osloensis

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