[Paediatric prescribing of anti-asthmatics in primary care in Castilla-León. Geographical variability]. / Prescripción pediátrica de fármacos antiasmáticos en atención primaria en Castilla y León. Variabilidad geográfica.

INTRODUCTION AND OBJECTIVES: Asthma is one of the most prevalent chronic diseases with effective treatment in paediatrics. The aim of this study is to describe the paediatric prescribing of anti-asthmatics in Castilla-León, analyzing its geographic variability and temporal evolution. MATERIAL AND METHODS: An analysis was made of prescriptions dispensed in pharmacies of R03 therapeutic subgroup (anti-asthmatic agents), and the active ingredients mepyramine and ketotifen, prescribed in children less than 14 years of age in the Castilla-León health service from 2005 to 2010 in Primary Care. Data is presented in prescribed daily doses per thousand inhabitants per day (PDHD) for each active ingredient being calculated raw rates and age-adjusted to the variables health area, type of health zone and year of study. RESULTS: A total of 462,354 prescriptions of anti-asthmatic agents were dispensed to a population of 1,580,229 persons/year. There was wide variation between areas in the type and intensity of anti-asthmatic agents used, partly explained by differences in the prevalence of asthma. Montelukast predominated as controller drug in most of them (PDHD 3.1 to 7.7), being similar the consumption intensity in the three types of health zones (PDHD 4.7 to 4.8). The annual variability was low. CONCLUSIONS: The study describes the paediatric prescribing pattern of anti-asthmatic agents in Castilla-León between 2005-2010. It shows wide geographical variation, as well as inadequacies regarding current recommendations of asthma treatment.

Prescripción pediátrica de fármacos antiasmáticos en atención primaria en Castilla y León. Variabilidad geográfica / Paediatric prescribing of anti-asthmatics in primary care in Castilla-León. Geographical variability

INTRODUCCIÓN Y OBJETIVOS: El asma es una de las enfermedades crónicas con tratamiento eficaz más prevalentes en pediatría. El objetivo de este trabajo es describir la prescripción pediátrica de antiasmáticos en Castilla y León, analizando su variabilidad geográfica y su evolución temporal. MATERIAL Y MÉTODOS: Se estudiaron las prescripciones dispensadas en farmacias del subgrupo terapéutico R03 (medicamentos antiasmáticos) y de los principios activos mepiramina y ketotifeno, realizadas a menores de 14 años en atención primaria en el Sistema Nacional de Salud entre 2005 y 2010. Los datos se presentan en dosis diarias prescritas por 1.000 habitantes/día (PDHD) para cada principio activo, calculándose tasas crudas y ajustadas por edad para las variables área sanitaria, tipo de zona de salud y año del estudio. RESULTADOS: Se realizaron 462.354 prescripciones de antiasmáticos a una población expuesta de 1.580.229 personas-año. Hubo amplia variabilidad entre las áreas en el tipo e intensidad de los antiasmáticos utilizados, en parte explicada por diferencias en su prevalencia de asma. Montelukast predominó como fármaco controlador en la mayoría de ellas (3,1-7,7 PDHD), siendo su intensidad de consumo similar en los 3 tipos de zonas de salud (4,7-4,8 PDHD). La variabilidad anual fue escasa. CONCLUSIONES: El estudio describe el patrón pediátrico de prescripción de antiasmáticos en Castilla y León entre 2005 y 2010. Muestra gran variabilidad geográfica, así como inadecuaciones respecto a las recomendaciones actuales de tratamiento del asma

INTRODUCTION AND OBJECTIVES: Asthma is one of the most prevalent chronic diseases with effective treatment in paediatrics. The aim of this study is to describe the paediatric prescribing of anti-asthmatics in Castilla-León, analyzing its geographic variability and temporal evolution. MATERIAL AND METHODS: An analysis was made of prescriptions dispensed in pharmacies of R03 therapeutic subgroup (anti-asthmatic agents), and the active ingredients mepyramine and ketotifen, prescribed in children less than 14 years of age in the Castilla-León health service from 2005 to 2010 in Primary Care. Data is presented in prescribed daily doses per thousand inhabitants per day (PDHD) for each active ingredient being calculated raw rates and age-adjusted to the variables health area, type of health zone and year of study. RESULTS: A total of 462,354 prescriptions of anti-asthmatic agents were dispensed to a population of 1,580,229 persons/year. There was wide variation between areas in the type and intensity of anti-asthmatic agents used, partly explained by differences in the prevalence of asthma. Montelukast predominated as controller drug in most of them (PDHD 3.1 to 7.7), being similar the consumption intensity in the three types of health zones (PDHD 4.7 to 4.8). The annual variability was low. CONCLUSIONS: The study describes the paediatric prescribing pattern of anti-asthmatic agents in Castilla-León between 2005-2010. It shows wide geographical variation, as well as inadequacies regarding current recommendations of asthma treatment

Prescripción off-label de antiasmáticos en Atención Primaria / Off-label prescription of anti-asthmatic agents in Primary Care

Introducción y objetivos: se denomina prescripción off-label a la realizada fuera de las condiciones autorizadas en la ficha técnica de un medicamento. En Atención Primaria se publican cifras globales de prescripción off-label en diferentes países del 3-67%. El objetivo del estudio ha sido conocer la intensidad de este tipo de prescripción en el caso de los antiasmáticos en un periodo reciente, en Castilla-León (España). Métodos: se analizaron las prescripciones correspondientes al subgrupo terapéutico R03 (medicamentos para enfermedades obstructivas respiratorias) realizadas a menores de 14 años entre 2005-2010 en el sistema público de salud autonómico. La información sobre el uso off-label se presenta en número de prescripciones consumidas de antiasmáticos a dosis y/o edades no recomendadas en su ficha técnica. Resultados: se realizaron 394876 prescripciones de antiasmáticos a una población expuesta de 1 580229 personas/año. Los menores de cuatro años fueron los que más antiasmáticos recibieron. La máxima prescripción de broncodilatadores ocurrió en menores de dos años, la de montelukast y corticoides inhalados monofármaco al año de edad. El 46% de las prescripciones de salbutamol sistémico y el 15,9% de las de la terapia de mantenimiento se prescribieron off-label. Conclusiones: el estudio muestra un uso importante de antiasmáticos a edades muy tempranas en las que es difícil hacer el diagnóstico de asma y un consumo notable de fármacos controladores a dosis y/o edades no autorizadas. La prescripción off-label no presupone una prescripción inadecuada, pero debería tener un beneficio real para el paciente y estar apoyada por avales científicos que justifiquen su uso (AU)

Introduction and objectives: off-label prescribing is when performed outside of the official information of the product. Overall figures of off-label prescribing in primary care in different countries are 3-67%. The aim of the study was to determine the intensity of this type of prescription in anti-asthmatic agents in a recent period of time, in Castilla y León. Methods: the requirements for the therapeutic subgroup R03 (anti-asthmatic agents) prescribed in children less than 14 years of age in the Castilla-León health service from 2005 to 2010 were analyzed. Information on off-label prescribing is shown in number of anti-asthmatic prescriptions consumed at doses and/or at ages not recommended in its technical specifications. Results: a total of 394 876 prescriptions for anti-asthmatic agents were performed to an exposed population of 1 580 229 person-years. Children under four years received the highest levels of anti-asthmatic agents. The maximum prescription of bronchodilators occurred in children under 2 years, and of montelukast and single inhaled corticosteroids at one year of age. 46% of prescriptions of systemic salbutamol and 15.9% of maintenance therapy prescriptions were made in an off-label manner. Conclusions: the study shows an important and very early use of anti-asthmatic agents at ages where it is difficult to make a diagnosis of asthma and also a remarkable consumption of controller therapy at not authorized dose and/or ages. Off-label prescription do not presuppose inappropriate prescription but it should have a real benefit to the patient and be supported by scientific guarantees to justify its use (AU)

Anti-asthmatic prescription variability in children according to age

INTRODUCTION: There is little research in the Spanish paediatric population about the consumption of anti-asthmatic agents. The aim of this study was to describe the current pattern of anti-asthmatic drug prescription in the paediatric population from a region of Spain, using the prescribed daily dose as a unit of measurement. METHODS: We analysed the requirements of R03 therapeutic subgroup (anti-asthmatic agents) in children less than 14 years of age in the Public Health System of Castilla y León from 2005 to 2010. Consumption data are presented in prescribed daily doses per thousand inhabitants per day (PDHD) and compared with defined daily doses per thousand inhabitants per day (DHD). RESULTS: 394 876 prescriptions of anti-asthmatics were given to a population of 1 580 229 persons/year. Bronchodilators, leukotriene receptor antagonists, single inhaled corticosteroids (ICS) and long-acting β2-adrenergics associated with inhaled corticosteroids were the most commonly prescribed drugs: 7.5, 5.2, 4.9 and 2.2 PDHD, respectively. The maximum prescription of bronchodilators (15.9 PDHD/9.8 DHD) occurred in children under 12 months, with montelukast (8.9 PDHD/3.6 DHD) and single inhaled corticosteroids (7.9 PDHD/2.9 DHD) at one year of age. CONCLUSIONS: Between 2005 and 2010, children under four years received a high prescription of anti-asthmatic drugs. The use of maintenance therapy was poorly aligned with the recommendations of asthma guidelines. The PDHD was more accurate for measuring consumption than DHD, especially in younger children

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Anti-asthmatic prescription variability in children according to age.

INTRODUCTION: There is little research in the Spanish paediatric population about the consumption of anti-asthmatic agents. The aim of this study was to describe the current pattern of anti-asthmatic drug prescription in the paediatric population from a region of Spain, using the prescribed daily dose as a unit of measurement. METHODS: We analysed the requirements of R03 therapeutic subgroup (anti-asthmatic agents) in children less than 14 years of age in the Public Health System of Castilla y León from 2005 to 2010. Consumption data are presented in prescribed daily doses per thousand inhabitants per day (PDHD) and compared with defined daily doses per thousand inhabitants per day (DHD). RESULTS: 394 876 prescriptions of anti-asthmatics were given to a population of 1 580 229 persons/year. Bronchodilators, leukotriene receptor antagonists, single inhaled corticosteroids (ICS) and long-acting ß2-adrenergics associated with inhaled corticosteroids were the most commonly prescribed drugs: 7.5, 5.2, 4.9 and 2.2 PDHD, respectively. The maximum prescription of bronchodilators (15.9 PDHD/9.8 DHD) occurred in children under 12 months, with montelukast (8.9 PDHD/3.6 DHD) and single inhaled corticosteroids (7.9 PDHD/2.9 DHD) at one year of age. CONCLUSIONS: Between 2005 and 2010, children under four years received a high prescription of anti-asthmatic drugs. The use of maintenance therapy was poorly aligned with the recommendations of asthma guidelines. The PDHD was more accurate for measuring consumption than DHD, especially in younger children.

Trombosis de senos venosos cerebrales en una niña con leucemia linfoblástica, portadora de la variante de la protrombina G20210A / Cerebral sinovenous thrombosis in a girl with acute lymphoblastic leukaemia carrying the prothrombin G20210A variant

Aunque la trombosis de senos venosos cerebrales es rara, se asocia con mayor frecuencia en niños con leucemia linfoblástica aguda. Se aporta el caso de una niña de 7 años que desarrolla una trombosis masiva de senos venosos cerebrales en el día 22 del tratamiento de inducción de leucemia linfoblástica aguda de alto riesgo. Clínicamente se manifestaron de forma progresiva cefalea, disminución del nivel de conciencia y hemiplejía izquierda. El estudio de trombofilia posterior reveló heterocigosis para la variante de la protrombina G20210A en la niña y en la madre. Se analizan los factores protrombóticos encontrados en el caso antes y después de la trombosis. Se confirma la importancia de investigar precozmente tanto los factores de riesgo de trombosis adquiridos como los estados de trombofilia primaria en niños con leucemia linfoblástica. Esta estrategia podría ayudar a identificar a pacientes de especial riesgo e instaurar en ellos tromboprofilaxis(AU)

Although cerebral venous thrombosis is rare, it is more commonly associated with children suffering from acute lymphoblastic leukaemia. We report the case of a 7-year-old girl who developed massive cerebral sinovenous thrombosis on day 22 of induction therapy for high-risk acute lymphoblastic leukaemia. Clinical symptoms were gradual onset of headache, decreasing consciousness, and ensuing left hemiplegia. A subsequent prothrombotic study revealed a heterozygous prothrombin G20210A variant in the child and mother. We analysed the prothrombotic factors found in the case before and after thrombosis. We confirm the importance of early exploration of patients for clinical predisposing risk factors of thrombosis and primary prothrombotic states in children with acute lymphoblastic leukaemia. This might help identify patients at particular risk from thrombosis and so administer thromboprophylaxis(AU)

Prescripción de fármacos anticatarrales de uso sistémico a niños de 0-13 años. Un problema no resuelto / Prescription of systemic cold and cough drugs to children 0-13 years old. An unresolved problem

Introducción y objetivos: La infección de las vías respiratorias superiores es el motivo de consulta pediátrica más frecuente, generando un elevado volumen de prescripción de fármacos con desfavorable relación riesgo-beneficio. El objetivo del estudio es describir la prescripción de anticatarrales por vía sistémica a menores de 14 años en Castilla y León y analizar su variabilidad. Población y métodos: Se contabilizaron las prescripciones de los subgrupos R05 (antitusivos y mucolíticos) y R01B (simpaticomiméticos) realizadas a menores de 14 años en el sistema público de salud entre 2005-2010. Se analizaron las prescripciones como tasas crudas y ajustadas por edad, y se realizó un análisis multivariante (regresión de Poisson) de la variabilidad relacionada con el área sanitaria, el ámbito urbano/rural, la edad y el año de prescripción. Resultados: Hubo 806.785 prescripciones de anticatarrales sistémicos realizadas a una población expuesta de 1.580.229 personas-año. Las tasas de prescripción (por 100 personas-año) fueron de 20,7 (antitusivos), 7,0 (simpaticomiméticos) y 23,4 (mucolíticos). Las tasas eran mayores en los niños menores de 4 años. La prescripción máxima de mucolíticos y simpaticomiméticos ocurrió a la edad de 1 año (tasas de 41,9 y 18,7) y la de antitusivos a los 3 años (35,7). El análisis multivariante demostró una mayor prescripción en el medio rural y diferencias notables entre áreas. El número de prescripciones disminuyó entre 2005 y 2010, pero no hubo una tendencia estable en esa reducción. Conclusiones: Entre 2005 y 2010 la prescripción de anticatarrales sistémicos fue alta, alejada de las recomendaciones internacionales de tratamiento y con una marcada variabilidad geográfica(AU)

Introduction and objectives: Upper respiratory tract infections are the most common cause of paediatric consultation, generating a high volume of prescriptions of drugs with unfavourable risk-benefit ratio. The aim of this study is to describe the prescription of systemic cough and cold medicines to children under 14 years of age in Castilla y León and analyse its variability. Population and methods: A count was made of the prescriptions for the R05 therapeutic subgroup (antitussives and mucolytics) and the R01B pharmacological therapeutic subgroup (nasal decongestants for systemic use), prescribed for children under the age of 14 in the Public Health System between 2005-2010. The number of prescriptions was analysed as crude and age-adjusted rates, as well as a a multivariate analysis (Poisson regression) of the variability associated with health area, the urban/rural environment, age, and year of prescription. Results: There were 806,785 prescriptions for systemic cough and cold drugs given to an exposed population of 1,580,229 person-years. Prescription rates (per 100 person-years) were 20.7 (antitussives), 7.0 (sympathomimetic) and 23.4 (mucolytics). These drugs were employed more often in children <4 years. The prescription of mucolytics and sympathomimetics was highest at age of 1 year (rates=41.9 and 18.7, respectively) and of antitussives at 3 years (35.7). Multivariate analysis showed that in rural areas the prescription was higher than in urban areas, and that there were also significant differences between health areas. Conclusions: Between 2005 and 2010 there was a high prescription of systemic cough and cold medicines, especially in children under 2 years old, and often outside the recommended conditions of use, and there was a high geographic variabilty(AU)

[Prescription of systemic cold and cough drugs to children 0-13 years old. An unresolved problem]. / Prescripción de fármacos anticatarrales de uso sistémico a niños de 0-13 años. Un problema no resuelto.

INTRODUCTION AND OBJECTIVES: Upper respiratory tract infections are the most common cause of paediatric consultation, generating a high volume of prescriptions of drugs with unfavourable risk-benefit ratio. The aim of this study is to describe the prescription of systemic cough and cold medicines to children under 14 years of age in Castilla y León and analyse its variability. POPULATION AND METHODS: A count was made of the prescriptions for the R05 therapeutic subgroup (antitussives and mucolytics) and the R01B pharmacological therapeutic subgroup (nasal decongestants for systemic use), prescribed for children under the age of 14 in the Public Health System between 2005-2010. The number of prescriptions was analysed as crude and age-adjusted rates, as well as a a multivariate analysis (Poisson regression) of the variability associated with health area, the urban/rural environment, age, and year of prescription. RESULTS: There were 806,785 prescriptions for systemic cough and cold drugs given to an exposed population of 1,580,229 person-years. Prescription rates (per 100 person-years) were 20.7 (antitussives), 7.0 (sympathomimetic) and 23.4 (mucolytics). These drugs were employed more often in children <4 years. The prescription of mucolytics and sympathomimetics was highest at age of 1 year (rates=41.9 and 18.7, respectively) and of antitussives at 3 years (35.7). Multivariate analysis showed that in rural areas the prescription was higher than in urban areas, and that there were also significant differences between health areas. CONCLUSIONS: Between 2005 and 2010 there was a high prescription of systemic cough and cold medicines, especially in children under 2 years old, and often outside the recommended conditions of use, and there was a high geographic variabilty.

[Cerebral sinovenous thrombosis in a girl with acute lymphoblastic leukaemia carrying the prothrombin G20210A variant]. / Trombosis de senos venosos cerebrales en una niña con leucemia linfoblástica, portadora de la variante de la protrombina G20210A.

Although cerebral venous thrombosis is rare, it is more commonly associated with children suffering from acute lymphoblastic leukaemia. We report the case of a 7-year-old girl who developed massive cerebral sinovenous thrombosis on day 22 of induction therapy for high-risk acute lymphoblastic leukaemia. Clinical symptoms were gradual onset of headache, decreasing consciousness, and ensuing left hemiplegia. A subsequent prothrombotic study revealed a heterozygous prothrombin G20210A variant in the child and mother. We analysed the prothrombotic factors found in the case before and after thrombosis. We confirm the importance of early exploration of patients for clinical predisposing risk factors of thrombosis and primary prothrombotic states in children with acute lymphoblastic leukaemia. This might help identify patients at particular risk from thrombosis and so administer thromboprophylaxis.

Ascorbate-dependent decrease of the mucosal immune inflammatory response to gliadin in coeliac disease patients

Background: The IL-15/NF-KappaB axis has an important role in coeliac disease (CD) and may represent a molecular target for immunomodulation. Ascorbate (vitamin C) is known to show inhibitory effects on NF-KappaB. Therefore, we studied if ascorbate supplementation to gliadin gliadin-stimulated biopsy culture could down-regulate the mucosal immune response to gliadin in CD. Methods: Duodenal biopsy explants from treated CD patients were gliadin challenged in vitro (100ìg/ml) with and without 20mM ascorbate. An extra tissue explant in basal culture was used as internal control. Secretion levels of nitrites (3h), and IFNGamma, TNFalpha, IFNalpha, IL-17, IL-13, and IL-6 (24h) were measured on the supernatants. IL-15 was assayed by western-blot on whole protein duodenal explants. Results: The addition of ascorbate to in vitro culture gliadin-challenged biopsies blocked the secretion of nitrites (p=0.013), IFNGamma (p=0.0207), TNFalpha (p=0.0099), IFNá (p=0.0375), and IL-6 (p=0.0036) compared to samples from non-ascorbate supplemented culture. Cytokine secretion was downregulated by ascorbate even to lower values than those observed in basal cultures (IFNGamma: p=0.0312; TNFalpha: p=0.0312; IFNá: p=0.0312; and IL-6: p=0.0078). Gliadin-challenge induced IL-15 production in biopsies from treated CD patients, while the addition of ascorbate to culture medium completely inhibited IL-15 production. Moreover, the inhibition of IL-15 by ascorbate took place even in the only treated CD-patient who had basal IL-15 production. Conclusions: Ascorbate decreases the mucosal inflammatory response to gluten in an intestinal biopsy culture model, so it might have a role in future supplementary therapy in CD(AU)

Ascorbate-dependent decrease of the mucosal immune inflammatory response to gliadin in coeliac disease patients.

BACKGROUND: The IL-15/NF-κB axis has an important role in coeliac disease (CD) and may represent a molecular target for immunomodulation. Ascorbate (vitamin C) is known to show inhibitory effects on NF-κB. Therefore, we studied if ascorbate supplementation to gliadin gliadin-stimulated biopsy culture could down-regulate the mucosal immune response to gliadin in CD. METHODS: Duodenal biopsy explants from treated CD patients were gliadin challenged in vitro (100 µg/ml) with and without 20mM ascorbate. An extra tissue explant in basal culture was used as internal control. Secretion levels of nitrites (3h), and IFNγ, TNFα, IFNα, IL-17, IL-13, and IL-6 (24h) were measured on the supernatants. IL-15 was assayed by western-blot on whole protein duodenal explants. RESULTS: The addition of ascorbate to in vitro culture gliadin-challenged biopsies blocked the secretion of nitrites (p=0.013), IFNγ (p=0.0207), TNFα (p=0.0099), IFNα (p=0.0375), and IL-6 (p=0.0036) compared to samples from non-ascorbate supplemented culture. Cytokine secretion was downregulated by ascorbate even to lower values than those observed in basal cultures (IFNγ: p=0.0312; TNFα: p=0.0312; IFNα: p=0.0312; and IL-6: p=0.0078). Gliadin-challenge induced IL-15 production in biopsies from treated CD patients, while the addition of ascorbate to culture medium completely inhibited IL-15 production. Moreover, the inhibition of IL-15 by ascorbate took place even in the only treated CD-patient who had basal IL-15 production. CONCLUSIONS: Ascorbate decreases the mucosal inflammatory response to gluten in an intestinal biopsy culture model, so it might have a role in future supplementary therapy in CD.

Morbilidad de los niños prematuros en edad escolar (II): patología respiratoria, alteraciones del crecimiento y presión arterial / Morbidity in premature children in school age (II): respiratory morbidity, alterations in the growth pattern and blood pressure

Objetivos: Conocer la morbilidad respiratoria, el patrón de crecimiento y la presión arterial (PA) en la edad escolar de los niños prematuros nacidos en nuestro hospital y compararlos con los de un grupo de niños nacidos a término. Pacientes y métodos: Estudio retrospectivo de cohortes históricas de niños prematuros nacidos en el Hospital Clínico de Valladolid desde enero de 1996 a diciembre de 2001. Se incluyeron en el estudio todos los niños con un peso al nacimiento ≤1.500 g y una edad gestacional (EG) ≤32 semanas (recién nacidos muy prematuros [RNMP]) y un grupo de niños prematuros con una EG de 330-366 semanas (recién nacidos prematuros tardíos [RNPT]). Se incluyó también una cohorte de recién nacidos a término (RNT) en el mismo periodo (EG de 37-42 semanas). Se citó a los niños para realizar anamnesis, exploración física y espirometría. Resultados: Participaron en el estudio 35 RNMP, 44 RNPT y 40 RNT. La prevalencia de patología respiratoria de vías bajas/sibilancias recurrentes en la edad escolar fue mayor en los prematuros que en los niños a término: RNMP 20%, RNPT 11,4% y RNT 2,5% (p= 0,038). En la espirometría encontramos una disminución del FEF25-75 en los RNMP respecto a los RNT. En edad escolar los niños RNMP presentan menor peso (puntuación Z de peso: –0,70 frente a 0,24; p= 0,007), y menor talla (puntuación Z de talla: –1,14 frente a 0,58; p= 0,000) que los niños a término. Los prematuros tardíos no muestran diferencias en la edad escolar respecto a los niños a término en peso ni en talla. La PA sistólica fue de 114,4 ± 11,6 mmHg en RNMP, de 108,3 ± 9,3 mmHg en RNPT y de 106,6 ± 9,1mmHg en RNT (p= 0,016). La PA diastólica fue de 64,7 ± 7,8mmHg en RNMP, de 62,2 ± 7,8 mmHg en RNPT y de 56,1 ± 6,3mmHg en RNT (p= 0,000)(AU). Conclusiones: Los niños prematuros presentan en la edad escolar una mayor prevalencia de patología de las vías respiratorias bajas que los niños nacidos a término, cuyo riesgo es mayor en los más inmaduros con antecedente de DBP. La recuperación tras la restricción posnatal del crecimiento de los RNMP no es suficiente, y en la edad escolar la talla y el peso de los RNMP es inferior a los de los niños a término. En los RNPT no hay diferencias en ninguno de estos dos parámetros respecto a los niños a término. La PA en la edad escolar, tanto sistólica como diastólica, es más alta en los niños cuanto más prematuros son (AU)

Objectives: To know the respiratory morbidity, the growth pattern and the blood pressure in premature children born a tour hospital of school age and to compare them with a group of full term children. Patients and methods: We studied a retrospective historical cohort of premature children born at the Clinical Hospital of Valladolid between January 1996 and December of 2001. In this study all the children who were born with ≤1,500 g and of gestational age (GA) ≤32 (VPNB: very premature) and other group of children born between 33,0-36,6 weeks (late preterm births). A cohort group of children born at term (babies born at term) during the same period of time between 37 and 42 weeks of gestation. History, physical examination and spirometry were obtained of each child. Results: 35 VPNB: very premature babies took part of the study, 44 late preterm babies and 40 babies born at term. The prevalence of respiratory pathology of the lower/recurrent wheezing tract episodes in school age was higher in premature than in full term infants: VPNB 20%, late preterm births 11.4%and babies born at term 2.5% (p 0.038). In the spirometry we find a decrease of FEF25-75 in the VPNB respect to babies born at term. In school age VPNB have lower weight than the full term infants (weight Z score –0.70 vs. 0.24, p 0.007) and lower height (height Z score –1.14 vs. 0.58, p 0.000). In school age late preterm infants have no difference with full term infants in weight and height. Systolic blood pressure was 114.4 ± 11.6 in VPNB, 108.3 ± 9.3 in late preterm and 106.6 ± 9.1 in full term (p 0.016). Diastolic blood pressure was 64.7 ± 7.8 in VLBW,62.2 ± 7.8 in late preterm babies and 56.1 ± 6.3 in babies born at term (p 0.000)(AU). Conclusions: Premature children at school age have a higher prevalence of pathology of lower recurrent wheezing episodes than infants born at term, being the risk higher in the most immature children who have had BPD. The recovery after the postnatal restriction growth of the VPNB is not enough and in school age the height and weight of the Preterm children is inferior to the children born at term. In the late preterm there is no difference in both parameters with the children born at term. The arterial blood pressure during school age, both systolic and diastolic, is higher in the children while more prematurely born (AU)

Morbilidad de los niños prematuros en edad escolar (I): alteraciones neurosensoriales, psicointelectivas y de conducta / Morbidity in premature children in school age (I): neurosensorial deficits, psycho-intellectual and behavior problems

Objetivos: Conocer las alteraciones motoras, neurosensoriales, psicointelectivas, emocionales y de conducta en niños muy prematuros y prematuros tardíos en edad escolar. Pacientes y métodos: Estudio de cohortes históricas de niños prematuros nacidos en el Hospital Clínico de Valladolid desde enero de 1996 hasta diciembre de 2001. Se incluyeron todos los recién nacidos (RN) con un peso al nacimiento ≤1.500 g y una edad gestacional (EG) ≤32 semanas (RN muy prematuros [RNMP]), y un grupo de niños con una EG de 33-36 semanas (RN prematuros tardíos [RNPT]). Se incluyó también una cohorte de RN a término (RNT) en el mismo periodo. Se citó a los niños en la consulta para realizar una entrevista sobre los problemas de salud y una exploración física completa a cada niño. Los datos de rendimiento escolar se tomaron de la entrevista a los padres. La valoración psicointelectiva y conductual fue realizada por una psicóloga infantil. Resultados: Participaron en el estudio 35 RNMP, 44 RNPT y40 RNT. La incidencia de parálisis cerebral fue del 11,4% en el grupo de RNMP. Tres de los RNMP tenían secuelas neurosensoriales graves: dos hipoacusia y uno ceguera bilateral. El coeficiente intelectual (CI) de los RNMP fue significativamente más bajo que el de los RNPT (91,23 ± 18,5 frente a 104,94 ±16,2; p= 0,002) y que el de los RNT (91,23 ± 18,5 frente a 107,08 ± 15,4; p= 0,000). En el 15,4% de los RNMP el CI fue muy bajo (<69), y ninguno de los niños de los otros dos grupos se encontraba en este nivel. Se observó una correlación significativa entre el CI y el perímetro cefálico en el momento del alta hospitalaria en los RNMP. Respecto a la psicomotricidad (valorada mediante el test de Ozerestky), presentaron una peor coordinación general los RNMP en relación con los otros dos grupos. Los problemas de conducta fueron más evidentes en los niños prematuros tardíos. El 37,1% de los RNMP presentaban un mal rendimiento escolar y precisaban clases de apoyo, frente al 18,2% de los RNPT y el 7,5% de los RNT (p= 0,005). El 42,9%de los RNMP mostraban secuelas globales: un 11,4% graves, un 17,1% moderadas y un 14,3% leves. En el grupo de RNPT la prevalencia de secuelas fue del 27,3%, y en el de RNT del 20% (p <0,001); en ambos grupos eran leves. Conclusiones: En la edad escolar, aproximadamente la mitad de los RNMP presentan alteraciones motoras, neurosensoriales, cognitivas o de conducta respecto a un grupo de RNT. Los prematuros tardíos presentaron una mayor incidencia de trastornos emocionales y/o de conducta que los RNMP y los RNT (AU)

Objectives: To estimate the effect of preterm birth and late preterm infant on motor development, psycho-intellectual, neurosensorial deficits and behavior problems in school aged children. Patients and methods: Historical cohort study of premature children born at the University Hospital of Valladolid, between January 1996 and December 2001. All the new borns, which weighed ≤1,500 g and had a gestation age of 32 or fewer completed weeks where included and very premature babies. Another group with children born between 33 and 36 complete weeks, late preterm infant. A cohort group of FT infants delivered at full term during the same time served as a comparison group. The children where all appointed to the consultation to have an interview about health problems and a complete physical exploration. The data of school performance was taken in an interview with the parents. The psycho-intellectual infantile pshychologist did a condcutible valoration. Results: In the study 35 infants very premature infants, 44 late preterm infants, and 40 FT infants were included. The incidence of cerebral paralysis was of 11.4% in the group of very premature infants. Three children of the group of very premature infants had severe neurosensorial consequences: two cases hypocausia and one was blind. The intelligence quotient in the VLBW was lower compared with the late preterm one(91.23 ± 18.5 vs. 104.94 ± 16.2, p= 0.002) and compared with full term infants (91.23 ± 18.5 vs 107.08 ± 15.4, p= 0.000). The15.4% of the VLBW had the lowest IQ level (<69) and a positive correlation was found between IQ at school age and head circumference at the time of hospital discharge. The overall motor impairment score evaluated with the Ozeretsky test were poorer in VLBW. The behavioral problems were higher in late premature infants. 37.1% of the VLBW, 18.2% in late preterm and 7.5% of full term infants have school problems and special support (p= 0.005). The global deficits in VLBW were severe in 11.4%, moderate in 17.1% and mild in 14.3%. The global deficits in the other two groups were mild: 27.3% of late preterm and 20% of full term infants (p <0.001).Conclusions: At school age, approximately half of every preterm infant is more likely to have motor, neurosensorial, cognitive, behavioral and emotional problems. Late preterm infants have higher psychological problems than VLBW and full term infants (AU)

Incidencia del cáncer infantil en la Comunidad de Castilla y León (2003–2007) / Incidence of childhood cancer in the autonomous region of Castilla y León in Spain (2003–2007)

Antecedentes: En España desde 1980 se registran los tumores infantiles en el Registro Nacional (base hospitalaria) y desde 1990 cinco comunidades autónomas poseen registros de base poblacional. En la Comunidad de Castilla y León no existe un registro específico de incidencia de cáncer infantil. Objetivos: Estimar la incidencia de cáncer infantil en la Comunidad de Castilla y León y analizar la utilidad de los diagnósticos informatizados del alta hospitalaria como fuente de datos de un potencial registro autonómico. Métodos: A través del Conjunto Mínimo Básico de Datos (CMBD) al alta hospitalaria de los hospitales públicos de la comunidad autónoma, se obtuvo información de los pacientes menores de 15 años que fueron diagnosticados por primera vez de cáncer durante los años 2003–2007.ResultadosSe han detectado 220 casos nuevos de cáncer infantil en los cinco años del estudio, con predominio del sexo masculino (55,5%). El tumor más frecuente fue la leucemia (28,6%) seguida de los tumores del sistema nervioso central (19,5%) y los linfomas (15,9%). La incidencia anual de cáncer infantil fue de 152,8 casos por millón de niños. Los códigos diagnósticos informatizados no permitieron la clasificación según la variedad histológica del tumor en 74 casos (33,6%). Conclusiones: La incidencia por grupos diagnósticos de cáncer infantil en la Comunidad de Castilla y León se aproxima a las aportadas en series nacionales e internacionales. En un registro de tumores el CMBD podría ser útil en la captación de posibles nuevos casos, pero en un alto porcentaje no permite clasificar los tumores según su variedad histológica (AU)

Background: Since 1980, childhood cancer cases have been registered in Spain in the National Registry of Childhood Cancer (based on hospital cases) and since 1990, five autonomous regions have had a population based registry. There is no specific registry of childhood cancer in Castilla y Leon. Objectives: Our aim was to estimate the childhood cancer incidence in the autonomous region of Castilla y Leon and to assess the usefulness of the computerised diagnosis of hospital discharges as a source of data in a potential autonomous region population based registry. Methods: We included patients younger than 15 years old who were diagnosed, for the first time, of cancer during the years 2003–2007. The information collected was obtained through the Minimum Basic Data Set (MBDS) of the public hospitals in the autonomous region of Castilla y Leon. Results: In this period of 5 years (2003–2007), 220 cases of childhood cancer had been reported. The most frequent cancer detected was leukaemia (28.6%) followed by the central nervous system tumours (19.5%) and lymphoma (15.9%). The overall rate of childhood cancer incidence was 152.8 cases per million children. The diagnostics codes did not allow tumours to be classified by their histological type in 74 cases (33.6%). Conclusions: The overall incidence by diagnostic groups of childhood cancer in the autonomous region of Castilla y Leon was similar to those reported by other national and international registries. In a Cancer registry the MBDS could be useful as a data source in the capture of new cases, but in a high percentage of cases it does not allow tumours to be classified by their histological type (AU)

Diabetes mellitus tipo 1 y ganglioneuroma retroperitoneal / Onset of diabetes type 1 and retroperitoneal ganglioneuroma

El ganglioneuroma es un tumor poco frecuente, benigno, perteneciente al grupo de los tumores neuroblásticos periféricos, que aparece sobre todo en la infancia. Los tumores procedentes de la cresta neural abarcan un amplio espectro de neoplasias que incluyen formas benignas (ganglioneuroma) y formas malignas (neuroblastoma). El ganglioneuroma puede proceder de un neuroblastoma diferenciado o puede ser diagnosticado deforma primaria. Aunque la mayoría de los ganglioneuromas se descubren de forma casual, pueden originar manifestaciones clínicas por la compresión de estructuras vecinas o por su actividad metabólica intrínseca. Presentamos un caso de ganglioneuroma retroperitoneal diagnosticado incidentalmente en una niña de 6 años de edadc on sintomatología clásica de diabetes mellitus (poliuria, polidipsia y pérdida ponderal) (AU)

Introduction: A ganglioneuroma is an uncommon tumor, which belongs to the peripheral neuroblastic tumors, which appear mainly during childhood. Tumors of neural crest originin clude a broad spectrum of neoplasias ranging from benign (ganglioneuroma) to malignant tumors (neuroblastoma).The ganglioneuroma might evolve from differentiating neuroblastoma or may be diagnosed as a primary manner. Although most of ganglioneuromas are discovered incidentally, they may originate clinical manifestations due to the compression of neighboring structures or by an intrinsic metabolic activity. Case report: We present a case of retroperitoneal ganglioneuroma incidentally discovered in a 6 years girl with classic sintomatology of type 1 diabetes (polyuria, polydipsia and weight loss) (AU)

Diet and prevalence of atopic eczema in 6 to 7-year-old schoolchildren in Spain: ISAAC phase III.

BACKGROUND: The prevalence of atopic dermatitis (AD), a chronic skin disease, has increased substantially in recent decades, and different factors have been implicated in its etiology. Although dietary habits are being investigated, few conclusive findings have been reported. Nevertheless, increased consumption of polyunsaturated fatty acids (PUFA) and a diet poor in antioxidants have been related to AD. OBJECTIVES: The objectives of this study were to investigate the association between AD, the intake of different foods, and the effect of a Mediterranean diet among Spanish schoolchildren aged 6 to 7. METHODS: We performed a cross-sectional study with 20 106 schoolchildren aged 6-7 years from 10 different areas of Spain. The participation rate was 76.50%. The prevalence of AD was assessed using the International Study of Asthma and Allergies in Childhood questionnaire and the criteria of the Spanish Academy of Dermatology. To calculate the Mediterranean diet score, we classified food into 2 groups: Mediterranean food, including fruit, seafood, vegetables, pulses, cereals, pasta, rice, and potatoes; and non-Mediterranean food, including meat, milk, and fast food. RESULTS: Milk was negatively associated with AD. Butter and nuts also were negatively associated, although statistical significance was only reached when these foods were consumed 3 or more times a week. CONCLUSIONS: We found no association between the Mediterranean diet score and AD and a positive association between AD and obesity.

Early infections and later allergic diseases

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