Pica y traumatismo craneoencefálico en un paciente adolescente: recuperación <> con paliperidona / Pica and traumatic brain injury in an adolescent: complete improvement with paliperidone

Presentamos el caso clínico de un adolescente varón de 15 años derivado a Psiquiatría Infanto-Juvenil por realizar ingestas repetitivas de sustancias no nutritivas como gomas de borrar, escamas psoriásicas o incluso pintura de la pared. Entre sus antecedentes somáticos de interés, conviene destacar la Enfermedad de Kawasaki y psoriasis, además de haber sufrido un traumatismo craneoencefálico (TCE) tras lo cual presentó una exacerbación del cuadro. Tras el fracaso en el manejo conductual realizado por parte de su madre y teniendo en cuenta sus rasgos de personalidad caracterizados por una elevada suspicacia y desconfianza hacia los demás, se decide iniciar tratamiento con paliperidona oral produciéndose una rotunda mejoría clínica. Durante todo el seguimiento posterior hasta su mayoría de edad, se ha mantenido la desaparición de la pica. Presentamos el primer caso clínico publicado en la bibliografía actual de un adolescente con el diagnóstico de pica y un TCE previo y una adecuada respuesta a paliperidon

We present a case report of a 15-year-old male adolescent who was referred to our consultation of Children and Adolescent Psychiatry due to persistent eating of non-nutritive substances like rubber, psoriatic scale or wall paint. The patient had the previous diagnostic of Kawasaki Disease and psoriasis. In addition, he had suffered a traumatic brain injury, after which he presented an exacerbation of the clinic. After behaviour therapy failure realized by his mother and taking into account his personality features with high suspicion and distrust of others, he was prescribed paliperidone oral treatment and pica disappeared. During all subsequent follow-up until the age of majority, the disappearance of pica has been maintained. We describe the first case report in the current bibliography of an adolescent with the diagnosis of pica, a previous traumatic brain injury and a good response to oral paliperidone.

Control preconcepcional en la diabetes: factores predisponentes y barreras / Preconception care in diabetes: Predisposing factors and barriers

Antecedentes y objetivo: El control preconcepcional ha demostrado reducir el riesgo del embarazo asociado a la diabetes, pero muchas mujeres siguen quedando gestantes sin planificación previa. Nuestro objetivo fue identificar los factores predisponentes y las barreras relacionadas con la realización de control preconcepcional. Material y métodos: Se incluyeron, de forma consecutiva, 50 mujeres con diabetes pregestacional (28 tipo 1) y 50 gestantes sin diabetes que acudían a nuestro centro. Se les pidió que cumplimentaran un cuestionario y se revisaron sus historias clínicas. Resultados: Las 33 pacientes con diabetes y control preconcepcional tenían una edad actual (34,3±5,3 años) y al diagnóstico de la diabetes (20,3±11,3 años) similares a las 17 pacientes sin control (31,8±5,3 y 19,1±10,6 años, respectivamente; p>0,1), pero estaban con más frecuencia viviendo en pareja (97% vs. 70,6%; p=0,014), laboralmente activas (69,7% vs. 29,4%; p=0,047), eran seguidas por un/a endocrinólogo/a (80,6% vs. 50%; p=0,034), habían tenido abortos previos (78,6% vs. 10%; p=0,001), y conocían la repercusión de la diabetes en el embarazo (87,5% vs. 58,8%; p=0,029). No hubo diferencias significativas en la toma de ácido fólico pregestacional entre las gestantes con y sin diabetes (23,8% vs. 32%; p>0,1). Conclusiones: En las pacientes con diabetes, acudir a control preconcepcional se asoció con vivir en pareja, estar laboralmente activas, conocer el riesgo de complicaciones, tener abortos previos y ser seguidas por un/a endocrinólogo/a. Existe un bajo porcentaje de preparación de la gestación, también en el grupo sin diabetes (AU)

Background and objective: Preconception care has been shown to decrease the risk of pregnancy-related complications in women with diabetes, but many women do not plan their pregnancies. Our aim was to identify the associated factors and barriers related to involvement of these women in preconception care. Material and methods: Fifty women with pregestational diabetes (28 with type 1 diabetes) and 50 non-diabetic pregnant women were consecutively enrolled at our hospital. They completed a questionnaire, and their medical histories were reviewed. Results: All 33 patients with diabetes who received preconception care had a similar current age (34.3±5.3 years) and age at diagnosis (20.3±11.3) than those with no preconception care (n=17) (31.8±5.3 and 19.1±10.6 years respectively; P>.1), but were more frequently living with their partners (97% vs. 70.6%; P=.014), employed (69.7% vs. 29.4%; P=.047), and monitored by an endocrinologist (80.6% vs. 50%; P=.034), had more commonly had previous miscarriages (78.6% vs. 10%; P=.001), and knew the impact of diabetes on pregnancy (87.5% vs. 58.8%; P=.029). The frequency of preconceptional folic acid intake was similar in pregnant women with and without diabetes (23.8% vs. 32%; P>.1). Conclusions: Preconception care of diabetic patients is associated to living with a partner, being employed, knowing the risks of pregnancy-related complications, having previous miscarriages, and being monitored by an endocrinologist. Pregnancy planning is infrequent in both women with and without diabetes (AU)

Preconception care in diabetes: Predisposing factors and barriers. / Control preconcepcional en la diabetes: factores predisponentes y barreras.

BACKGROUND AND OBJECTIVE: Preconception care has been shown to decrease the risk of pregnancy-related complications in women with diabetes, but many women do not plan their pregnancies. Our aim was to identify the associated factors and barriers related to involvement of these women in preconception care. MATERIAL AND METHODS: Fifty women with pregestational diabetes (28 with type 1 diabetes) and 50 non-diabetic pregnant women were consecutively enrolled at our hospital. They completed a questionnaire, and their medical histories were reviewed. RESULTS: All 33 patients with diabetes who received preconception care had a similar current age (34.3±5.3 years) and age at diagnosis (20.3±11.3) than those with no preconception care (n=17) (31.8±5.3 and 19.1±10.6 years respectively; P>.1), but were more frequently living with their partners (97% vs. 70.6%; P=.014), employed (69.7% vs. 29.4%; P=.047), and monitored by an endocrinologist (80.6% vs. 50%; P=.034), had more commonly had previous miscarriages (78.6% vs. 10%; P=.001), and knew the impact of diabetes on pregnancy (87.5% vs. 58.8%; P=.029). The frequency of preconceptional folic acid intake was similar in pregnant women with and without diabetes (23.8% vs. 32%; P>.1). CONCLUSIONS: Preconception care of diabetic patients is associated to living with a partner, being employed, knowing the risks of pregnancy-related complications, having previous miscarriages, and being monitored by an endocrinologist. Pregnancy planning is infrequent in both women with and without diabetes.