Tos ferina, una enfermedad reemergente / Whooping cough, a re-emerging disease

Objetivo. Estamos asistiendo a una reemergencia de la tos ferina. Los lactantes que no han completado la primo-vacunación son el grupo de riesgo más vulnerable. La transmisión de la infección se asocia normalmente a un contacto domiciliario. Para ponerlo de manifiesto hemos desarrollado esta revisión. Material y métodos. Estudios descriptivo, retrospectivo, mediante revisión de serie de casos de pacientes con diagnóstico microbiológico de tos ferino ingresados en el Hospital Universitario Virgen Macarena desde Enero de 2006 a Junio de 2013. Resultados. Total de pacientes diagnosticados de tos ferina: 49. Aumento de la incidencia de la enfermedad en los últimos años, con un 75,5% de los casos entre enero de 2010 a junio de 2013. Un 83,7% de los pacientes fueron menores de 6 meses. Dos de ellos son diagnosticados de tos ferina maligna con evolución favorable tras exanguinotransfusión. Mayor días de ingreso para los pacientes de menor edad. El estudio mediante PCR en secreción nasofaríngea fue positivo en un 53,8% de los familiares estudiados. Conclusiones. Parece importante plantear un cambio en la estrategia de vacunación actual frente a la tos ferina, para disminuir la incidencia de la misma en los distintos grupos de edad y sus complicaciones como la tos ferina maligna (AU)

Goal. We are witnessing a resurgence of pertussis, being the infants who have not completed the primary vaccination yet the most vulnerable risk group. The transmission of the infection is usually associated to a household contact. To show it, we have developed this review. Material and methods. A Descriptive, retrospective study based on the review of a number of cases of patients with microbiological diagnosis of pertussis admitted to the Virgen Macarena University Hospital from January 2006 to June 2013. Results. The total number of patients diagnosed with pertussis was 49. It shows an increase in the incidence of the disease in recent years, with 75.5% of cases between January 2010 to June 2013. Most patients, 83,7%, were less than 6 moths. Two of them are diagnosed with malignant pertussis favorable outcome after exchange transfusion. The average time of hospitalization is higher for younger patients. The study by PCR in nasopharyngeal secretions was positive in 53,8% of the relatives studied. Conclusions. In view of the data presented, it seems important to change the current vaccination strategy with respect to the pertussis to reduce its incidence in the different age groups and its complications such as malignant pertussis (AU)

[Immunisation schedule of the Spanish Association of Paediatrics: 2013 recommendations]. / Calendario de vacunaciones de la Asociación Española de Pediatría: recomendaciones 2013.

The Advisory Committee on Vaccines of the Spanish Association of Paediatrics (CAV-AEP) updates the immunisation schedule every year, taking into account epidemiological data as well as evidence on the safety, effectiveness and efficiency of vaccines. The present schedule includes levels of recommendation. We have graded as routine vaccinations those that the CAV-AEP consider all children should receive; as recommended those that fit the profile for universal childhood immunisation and would ideally be given to all children, but that can be prioritised according to the resources available for their public funding; and as risk group vaccinations those that specifically target individuals in situations of risk. Immunisation schedules tend to be dynamic and adaptable to ongoing epidemiological changes. Nevertheless, the achievement of a unified immunisation schedule in all regions of Spain is a top priority for the CAV-AEP. Based on the latest epidemiological trends, CAV-AEP follows the innovations proposed in the last year's schedule, such as the administration of the first dose of the MMR and the varicella vaccines at age 12 months and the second dose at age 2-3 years, as well as the administration of the Tdap vaccine at age 4-6 years, always followed by another dose at 11-14 years of age, preferably at 11-12 years. The CAV-AEP believes that the coverage of vaccination against human papillomavirus in girls aged 11-14 years, preferably at 11-12 years, must increase. It reasserts its recommendation to include vaccination against pneumococcal disease in the routine immunisation schedule. Universal vaccination against varicella in the second year of life is an effective strategy and therefore a desirable objective. Vaccination against rotavirus is recommended in all infants due to the morbidity and elevated healthcare burden of the virus. The Committee stresses the need to vaccinate population groups considered at risk against influenza and hepatitis A. Finally, it emphasizes the need to bring incomplete vaccinations up to date following the catch-up immunisation schedule.

Manejo y actualización de las vacunas frente al virus del papiloma humano (VPH) en Pediatría / Management and up-date of the human papiloma virus (HPV) vaccines in Pediatrics

Los autores hacen una revisión de conjunto y puesta al día sobre los aspectos pediátricos más relevantes aparecidos en el curso de los últimos años sobre las vacunas frente al virus del papiloma humano (VPH), señalando la relación existente entre el VPH y el desarrollo del cáncer de cuello uterino (CCU). Actualmente es admitido por la comunidad científica internacional que el VPH es causa necesaria, aunque no suficiente, para la producción del CCU y otras localizaciones de cáncer en el área genital, si bien deben coexistir otros factores adicionales y determinantes de la carcinogénesis. Se realiza un resumen de la clasificación de los distintos grupos del VPH, señalando aquellos tipos patógenos y las enfermedades producida por ellos. Mención especial merecen la epidemiología, conductas sexuales y su relación con laa transmisión de la infección, analizando los datos de los estudios existentes en nuestro país. Se describen también las principales formas clínicas, su expresión, así como los métodos diagnósticos más importantes recogidos en la literatura. Describimos brevemente el procedimiento de obtención de las vacunas frente al VPH por la técnica de virus like particles (partículas similares al virus), confirmando se trata de vacunas profilácticas y no terapéuticas, sin genoma ni capacidad infectiva. En España se encuentra comercializadas y autorizadas dos vacunas desde el2007-2008; se denominan Gardasil®, tetravalente de Sanofi Pasteur MSD y Cervarix®, bivalente de GlaxoSmithKline, con una eficacia, inmunogenicidad y seguridad próximas al 100%. Revisamos igualmente los datos sobre eficacia en hombres de la vacuna tetravalente aparecidos recientemente. Las recomendaciones de la vacunación por VPH en nuestro país, se establecieron por el Consejo (AU)

A review is made of the group and an up-date made on the most relevant pediatric aspects that have appeared over recent years on human papiloma virus (HPV) vaccines, pointing out the relation existing between human papiloma virus and the develop of uterine cervical cancer. At present, the scientific community accepts that the human papilloma virus is a necessary but not sufficient cause for the production of uterine cervical cancer and other localizations in the genital area, although other additional factors and determinats of cervical carcinogenesis must exist. A summary is made of the classification of the different papilloma virus groups, indicating those pathogen types and diseases relatied with them. Special mention is made to the epidemiology of the disease, virus transmission, sexual behavior and relation to the transmission of the disease. The study data on sexual behaviors in our country are analyzed. Some comments are made on the clinical manifestations of the different diseases caused by human papillomas and an update is made of the Bethesda classification, mentioning the principal methods of detection of the human papilloma virus and utility in the diagnosis. The principal identification test are indicated as the PCR and hybrid capture. A brief description was made on how the vaccines are obtained for HPV using the virus like technique (particles similar to the virus), indicating that these are prophylactic and never therapeutic vaccines, with no genome and therefore without any infective capacity. In Spain, 2 vaccines have been on the market since the year 2007-2008 and approved by the AEMPS through the procedure centralized through the European Drug Agency. These vaccines are the tetravalent called Gardasil® Sanofi Pasteur MSD, effective against types 6, 11, 16 and 18 and the bivalent Cervarix® of GlaxoSmithKline, effective against types 16 and 18. Both vaccines have a demonstrated efficacy of about 100% (AU)

Calendario de vacunaciones de la Asociación Española de Pediatría: recomendaciones 2012 / Immunization schedule of the Spanish Association of Pediatrics: 2012 recommendations

El Comité Asesor de Vacunas de la Asociación Española de Pediatría (CAV-AEP) actualiza anualmente el calendario de vacunaciones teniendo en cuenta tanto aspectos epidemiológicos, como de efectividad y eficiencia de las vacunas. El presente calendario incluye grados de recomendación. Se han considerado como vacunas sistemáticas aquellas que el CAV-AEP estima que todos los niños deberían recibir; como recomendadas las que presentan un perfil de vacuna sistemática en la edad pediátrica y que es deseable que los niños reciban, pero que pueden ser priorizadas en función de los recursos para su financiación pública; y dirigidas a grupos de riesgo aquellas con indicación preferente para personas en situaciones de riesgo. Los calendarios de vacunaciones tienen que ser dinámicos y adaptarse a los cambios epidemiológicos que vayan surgiendo, pero el CAV-AEP considera como objetivo prioritario la consecución de un calendario de vacunación único para toda España.Teniendo en cuenta los últimos cambios en la epidemiología de las enfermedades, las principales novedades propuestas en este calendario son la administración de la primera dosis de las vacunas triple vírica y varicela a los 12 meses (12-15 meses) y la segunda dosis a los 2-3 años, así como la administración de la vacuna Tdpa a los 4-6 años siempre acompañada de otra dosisa los 11-14 años. El CAV-AEP estima que deben incrementarse las coberturas de vacunación frente al papiloma virus humano en las niñas de 11 a 14 años. Se reafirma en la recomendación de incluir la vacunación frente al neumococo en el calendario de vacunación sistemática. La vacunación universal frente a la varicela en el segundo año de vida es una estrategia efectiva y por tanto un objetivo deseable. La vacunación frente al rotavirus, dada la morbilidad y la elevada carga sanitaria, es recomendable en todos los lactantes. Se insiste en la necesidad de vacunar frente a la gripe y la hepatitis A a todos los que presenten factores de riesgo para dichas enfermedades. Finalmente, se insiste en la necesidad de actualizar las vacunaciones incompletas con las pautas de vacunación acelerada (AU)

The Advisory Committee on Vaccines of the Spanish Association of Pediatrics (CAVAEP) updates the immunization schedule every year, taking into account epidemiological data as well as evidence on the effectiveness and efficency of vaccines.The present schedule includes grades of recommendation. We have graded as routine vaccinations those that the CAV-AEP believes all children should receive; as recommended those that fit the profile for universal childhood immunization and would ideally be given to all children, but that can be prioritized according to the resources available for their public funding; and as risk group vaccinations those that specifically target individuals in situations of risk. Immunization schedules tend to be dynamic and adaptable to on going epidemiological changes. Nevertheless, the achievement of a unified immunization schedule in all regions of Spainis a top priority for the CAV-AEP. Based on the latest epidemiological trends, the main changes introduced to the schedule are the administration of the first dose of the MMR and the varicella vaccines at age 12 months(12---15 months) and the second dose at age 2---3 years, as well as the administration of the Tdap vaccine at age 4---6 years, always followed by another dose at 11---14 years of age.The CAV-AEP believes that the coverage of vaccination against human papilloma virus in girls aged 11---14 years must increase. It reasserts its recommendation to include vaccination against pneumococcal disease in the routine immunization schedule. Universal vaccination against varicellain the second year of life is an effective strategy and therefore a desirable objective. Vaccination against rotavirus is recommended in all infants due to the morbidity and elevated healthcare burden of the virus. The Committee stresses the need to vaccinate population groups considered at risk against influenza and hepatitis A. Finally, it emphasizes the need to bring incomplete vaccinations up to date following the catch-up immunization schedule (AU)

Vacunación frente a la gripe estacional en la infancia y la adolescencia. Recomendaciones del CAV-AEP para la campaña 2011-2012 / Seasonal influenza vaccination in children and adolescents. Recommendations of the CAV-AEP for the campaign

El Comité Asesor de Vacunas de la Asociación Española de Pediatría emite todos los años, antes del inicio de la temporada estacional de la gripe, unas recomendaciones sobre la vacunación frente a este virus en la edad pediátrica. Este comité sigue considerando que la vacunación antigripal es una actuación especialmente beneficiosa cuando va dirigida a los niños mayores de 6 meses pertenecientes a los grupos de riesgo, así como a sus convivientes. Se insiste en la recomendación de la vacunación antigripal en el personal sanitario que trabaja con niños (AU)

The Advisory Committee on Vaccines of the Spanish Association of Paediatrics establishes annual recommendations on influenza vaccination in childhood before the onset of influenza season. Routine influenza vaccination is particularly beneficial when the strategy isaimed at children older than 6 months of age with high-risk conditions and their home contacts.The recommendation of influenza vaccination in health workers with children is also emphasised (AU)

Immunization schedule of the Spanish Association of Pediatrics: 2012 recommendations.

The Advisory Committee on Vaccines of the Spanish Association of Pediatrics (CAV-AEP) updates the immunization schedule every year, taking into account epidemiological data as well as evidence on the effectiveness and efficiency of vaccines. The present schedule includes grades of recommendation. We have graded as routine vaccinations those that the CAV-AEP believes all children should receive; as recommended those that fit the profile for universal childhood immunization and would ideally be given to all children, but that can be prioritized according to the resources available for their public funding; and as risk group vaccinations those that specifically target individuals in situations of risk. Immunization schedules tend to be dynamic and adaptable to ongoing epidemiological changes. Nevertheless, the achievement of a unified immunization schedule in all regions of Spain is a top priority for the CAV-AEP. Based on the latest epidemiological trends, the main changes introduced to the schedule are the administration of the first dose of the MMR and the varicella vaccines at age 12 months (12-15 months) and the second dose at age 2-3 years, as well as the administration of the Tdap vaccine at age 4-6 years, always followed by another dose at 11-14 years of age. The CAV-AEP believes that the coverage of vaccination against human papillomavirus in girls aged 11-14 years must increase. It reasserts its recommendation to include vaccination against pneumococcal disease in the routine immunization schedule. Universal vaccination against varicella in the second year of life is an effective strategy and therefore a desirable objective. Vaccination against rotavirus is recommended in all infants due to the morbidity and elevated healthcare burden of the virus. The Committee stresses the need to vaccinate population groups considered at risk against influenza and hepatitis A. Finally, it emphasizes the need to bring incomplete vaccinations up to date following the catch-up immunization schedule.

[Seasonal influenza vaccination in children and adolescents. Recommendations of the CAV-AEP for the campaign]. / Vacunación frente a la gripe estacional en la infancia y la adolescencia. Recomendaciones del CAV-AEP para la campaña 2011-2012.

The Advisory Committee on Vaccines of the Spanish Association of Paediatrics establishes annual recommendations on influenza vaccination in childhood before the onset of influenza season. Routine influenza vaccination is particularly beneficial when the strategy is aimed at children older than 6 months of age with high-risk conditions and their home contacts. The recommendation of influenza vaccination in health workers with children is also emphasized.

Calendario de vacunaciones de la Asociación Española de Pediatría: recomendaciones 2011 / Vaccination schedule of the Spanish Association of Paediatrics: recommendations 2011

El Comité Asesor de Vacunas (CAV) de la Asociación Española de Pediatría actualiza anualmente el calendario de vacunaciones teniendo en cuenta tanto aspectos epidemiológicos, como de efectividad y eficiencia de las vacunas. El presente calendario incluye grados de recomendación. Se han considerado como vacunas sistemáticas aquellas que el CAV estima que todos los niños deberían recibir, como recomendadas las que presentan un perfil de vacuna sistemática en la edad pediátrica y que es deseable que los niños reciban, pero que pueden ser priorizadas en función de los recursos para su financiación pública, y dirigidas a grupos de riesgo aquellas con indicación preferente para personas en situaciones epidemiológicas de riesgo. El CAV considera como objetivo prioritario la consecución de un calendario de vacunaciones único para toda España. El CAV se reafirma en la recomendación de incluir la vacunación frente a neumococo en el calendario de vacunación sistemática. La vacunación universal frente a varicela en el segundo año de vida es una estrategia efectiva y por tanto un objetivo deseable. La vacunación frente a rotavirus, dada la morbilidad y la elevada carga sanitaria, es recomendable en todos los lactantes. Debido a los problemas actuales de disponibilidad de las vacunas, relacionados con la presencia de circovirus, el CAV insta a que, tan pronto como sea posible, se reinicie la vacunación frente a rotavirus por considerarla una oferta de salud deseable para todos los niños en nuestro país. El CAV se adhiere a las recomendaciones del Consejo Interterritorial del Sistema Nacional de Salud en referencia al la vacunación sistemática frente al virus del papiloma humano de todas las niñas de 11 a 14 años e insiste en la necesidad de vacunar frente a la gripe y hepatitis A, a todos los que presenten factores de riesgo para dichas enfermedades. Finalmente, se insiste en la necesidad de actualizar las vacunaciones incompletas con las pautas de vacunación acelerada (AU)

The Advisory Committee on Vaccines of the Spanish Paediatric Association updates annually the immunization schedule, taking into account epidemiological data as well as evidence of the effectiveness and efficiency of vaccines. This vaccination schedule includes grades of recommendation. The committee has graded as universal vaccines those that all children should receive, as recommended, those with a profile of universal vaccines of childhood and as are desirable those that all children may receive, but that can be prioritized based on public funding resources and for risk groups, targeting those groups of people in epidemiological situations of risk. The Committee considers as a priority to achieve a common immunization schedule for Spain. The Committee reaffirms the recommendation to include pneumococcal vaccination in the routine vaccination schedule. Vaccination against varicella in the second year of life is an effective strategy and therefore a desirable goal. Given the morbidity and high burden on the health care system, vaccination against rotavirus is recommended for all infants. Due to the current problems of availability of both vaccines, associated with the recent finding of circovirus, the committee urges that rotavirus vaccination is restarted as soon as possible as it is considered a desirable health benefit for all children in our country. The Committee adheres to the recommendations of the National Health Coordination Council in reference to routine vaccination against HPV for all girls aged 11 to 14 years and stresses the need to vaccinate all patients with risk factors for these diseases against influenza and hepatitis A. Finally, it stresses the need to update incomplete immunizations using accelerated immunization schedules (AU)

[Vaccination schedule of the Spanish Association of Paediatrics: recommendations 2011]. / Calendario de vacunaciones de la Asociación Española de Pediatría: recomendaciones 2011.

The Advisory Committee on Vaccines of the Spanish Paediatric Association updates annually the immunization schedule, taking into account epidemiological data as well as evidence of the effectiveness and efficiency of vaccines. This vaccination schedule includes grades of recommendation. The committee has graded as universal vaccines those that all children should receive, as recommended, those with a profile of universal vaccines of childhood and as are desirable those that all children may receive, but that can be prioritized based on public funding resources and for risk groups, targeting those groups of people in epidemiological situations of risk. The Committee considers as a priority to achieve a common immunization schedule for Spain. The Committee reaffirms the recommendation to include pneumococcal vaccination in the routine vaccination schedule. Vaccination against varicella in the second year of life is an effective strategy and therefore a desirable goal. Given the morbidity and high burden on the health care system, vaccination against rotavirus is recommended for all infants. Due to the current problems of availability of both vaccines, associated with the recent finding of circovirus, the committee urges that rotavirus vaccination is restarted as soon as possible as it is considered a desirable health benefit for all children in our country. The Committee adheres to the recommendations of the National Health Coordination Council in reference to routine vaccination against HPV for all girls aged 11 to 14 years and stresses the need to vaccinate all patients with risk factors for these diseases against influenza and hepatitis A. Finally, it stresses the need to update incomplete immunizations using accelerated immunization schedules.

Calendario de vacunaciones de la Asociación Española de Pediatría: recomendaciones 2010 / Vaccination schedule of the spanish association of paediatrics: recommendations 2010

El Comité Asesor de Vacunas (CAV) de la Asociación Española de Pediatría actualiza anualmente el calendario de vacunaciones teniendo en cuenta, tanto aspectos epidemiológicos como de efectividad y eficiencia de las vacunas. El presente calendario incluye grados de recomendación. Se han considerado como vacunas sistemáticas aquellas que el CAV estima que todos los niños deberían recibir, como recomendadas las que presentan un perfil de vacuna sistemática en la edad pediátrica y que es deseable que los niños reciban, pero que pueden ser priorizadas en función de los recursos para su financiación pública y dirigidas a grupos de riesgo aquellas con indicación preferente para personas en situaciones epidemiológicas de riesgo. El CAV considera como objetivo prioritario la consecución de un calendario de vacunaciones único. El CAV se reafirma en la recomendación de incluir la vacunación frente a neumococo en el calendario de vacunación sistemática. La vacunación universal frente a varicela en el segundo año de vida es una estrategia efectiva y por tanto un objetivo deseable. La vacunación frente a rotavirus, dada la morbilidad y la elevada carga sanitaria, es recomendable en todos los lactantes. El CAV se adhiere a las recomendaciones del Consejo Interterritorial del Sistema Nacional de Salud en referencia a la vacunación sistemática frente a VPH de todas las niñas de 11 a 14 años e insiste en la necesidad de vacunar frente a la gripe y hepatitis A a todos los pacientes que presentan factores de riesgo para dichas enfermedades. Finalmente se insiste en la necesidad de actualizar las vacunaciones incompletas con las pautas de vacunación acelerada (AU)

The Vaccine Advisory Committee of the Spanish Association of Paediatrics updates annually, the immunization schedule, taking into account epidemiological data, as well as evidence of the effectiveness and efficiency of vaccines. This vaccination schedule includes grades of recommendation. The committee has graded as universal vaccines those that all children should receive, as recommended those with a profile of universal vaccination in childhood and which are desirable that all children receive, but that can be prioritized based on resources for its public funding and for risk groups those targeting groups of people in situations of epidemiological risk. The Committee considers as a priority to achieve a common immunization schedule. The Committee reaffirms the recommendation to include pneumococcal vaccination in the routine vaccination schedule. Vaccination against varicella in the second year of life is an effective strategy and therefore a desirable goal. Vaccination against rotavirus is recommended for all infants given the morbidity and high burden on the health care system. The Committee adheres to the recommendations of the Interterritorial Council of the National Health Care System in reference to routine vaccination against HPV for all girls aged 11 to 14 years and stresses the need to vaccinate against influenza and hepatitis A all patients with risk factors for these diseases. Finally, it stresses the need to update incomplete immunization schedules using accelerated immunization schedules (AU)

[Vaccination schedule of the Spanish association of paediatrics: recommendations 2010]. / Calendario de vacunaciones de la Asociación Española de Pediatría: recomendaciones 2010.

The Vaccine Advisory Committee of the Spanish Association of Paediatrics updates annually, the immunization schedule, taking into account epidemiological data, as well as evidence of the effectiveness and efficiency of vaccines. This vaccination schedule includes grades of recommendation. The committee has graded as universal vaccines those that all children should receive, as recommended those with a profile of universal vaccination in childhood and which are desirable that all children receive, but that can be prioritized based on resources for its public funding and for risk groups those targeting groups of people in situations of epidemiological risk. The Committee considers as a priority to achieve a common immunization schedule. The Committee reaffirms the recommendation to include pneumococcal vaccination in the routine vaccination schedule. Vaccination against varicella in the second year of life is an effective strategy and therefore a desirable goal. Vaccination against rotavirus is recommended for all infants given the morbidity and high burden on the health care system. The Committee adheres to the recommendations of the Interterritorial Council of the National Health Care System in reference to routine vaccination against HPV for all girls aged 11 to 14 years and stresses the need to vaccinate against influenza and hepatitis A all patients with risk factors for these diseases. Finally, it stresses the need to update incomplete immunization schedules using accelerated immunization schedules.

Fiebre y convulsiones en lactante de 4 meses / A 4-month-old infant with fever and seizures

No disponible

Calidad de vida, satisfacción y adherencia terapéutica en dermatitis atópica / Quality of life, satisfaction and therapeutic adherence in atopic dermatitis

Obejtivos: Evaluar la Calidad de Vida Relacionada con la Salud (CVRS) de los cuidadores de pacientes pediátricos con dermatitis atópica (DA) mediante el cuestionario Parents Index of Quality of Life in Atopic Dermatitis (PIQOL-AD) y el cuestionario EuroQoL-5D (EQ-5D) y conocer la satisfacción y la adherencia terapçeutica mediante el cuestionario Morisky Green. Métodos: Estudio observacional, multicéntrico y ambispectivo de 9 meses de seguimiento. 372 pacientes menores de 12 años con DA de 78 centros españoles distribuidos en dos grupos; pacientes de 0-23 meses y de 24 meses a 12 años. Se recogieron variables de gravedad (IGA, EASI), de CVRS, pregutnas sobre satisfacción con tratamiento y el cuestionario de adherencia. Resultados: La edad media (DE) de los pacientes fue de 4,2 (3,2) años. Las puntuaciones del PIQoL-AD se relacionaron con la gravedad del paciente (p<0.0001). Mayor preocupación por; "tener cuidado con la ropa que debía llevar el niño" (84,6%) y "por el aspecto del niño" (80,8%). Relación entre gravedad (IGA) y las puntuaciones EQ-5D; a mayor gravedad, mayor porcentaje de cuidadores con problemas en dolor/malestar y ansiedad/depresión. A los 9 meses la puntuación de la EVA de los cuidadores aumentó de forma estadísticamente significativa. El 83% de los cuidadores con pacientes sin casi enfermedad declararon estar muy o bastante satisfechos y el 25.3% una adherencia alta al tratamiento. Conclusiones: La gravedad de la DA es el factor que más condiciona con el tratamiento y en el grado de cumplimiento terapéutico

Objectives: To evaluate the Health-Related Quality of Life (HRQoL) of the pediatric patient´s caregivers with Atopic Dermatitis (AD) measured by Parents Index of Quality of Life in Atopic Dermatitis questionnaire (PIQOL-AD) and EuroQoL-5D questionnaire (EQ-5D) and know the treatment satisfaction and therapeutic compliance using Morisky Green questionnaire. Methods: Observationa, multicentric and ambispective study with a 9 months of prospective phase. 372 patients <= 12 years old with AD from 78 centers of Spain. Patients were allocated in two defferent groups, patients from 0-23 months and patients from 24 months to 2 years old. Patients with AD and whose caregiver may attend all study visits. We collect severity variables (Investigator´s Global Assessment (IGA), EASI), HRQoL (EQ-5D, PIQoL.AD), questions about treatment satisfaction and Morisky Green questionnaire. Results: Mean age (ED) was 4,2 (3,2) years old. PIQoL-AD scores have correlation with patient severity (p<0,001). Patient´s caregivers major concerns were about "be careful with the clothes that the children may wear" (84,6%) and "skin´s childrens aspects" (80.8%). Relationship between severity (IGA) and EQ-5D questionnaire scores. After 9 months of follow up, scores of analogical visual scales (AVS) of EQ-5D increased statistically significant, 83% of the patient´s caregivers with less severity declare to be more or quite satisfied with the treatment. The scores of the adherence questionnaire showed that 25,3% of the patients had a high adherence to the treatment. Conclusions: Results shows that severity of AD is the most conditioning factor in the caregivers day life, in the treatment satisfaction and adherence compliance (AU)

Absceso cerebral / Brain abscess

El absceso cerebral es una patología poco frecuente en la infancia, aunque grave, que puede presentar una alta morbimortalidad, a pesar de los avances diagnósticos y terapéuticos actuales. El germen causal depende de los factores predisponentes. La presentación clínica en niños es inespecífica, y requiere la sospecha precoz por parte del médico. La tomografía computarizada (TC) y/o la resonancia magnética (RM) son herramientas indispensables para realizar el diagnóstico de certeza. El tratamiento de la mayoría de los abscesos consiste en antibioterapia de amplio espectro y drenaje quirúrgico, aunque en la fase precoz de cerebritis puede responder sólo a tratamiento médico. Describimos una niña de 13 años diagnosticada de dos abscesos cerebrales originados a partir de una otitis media y que se encontraba en tratamiento antibiótico. Presentaba cefalea, vómitos y otalgia a su ingreso. El diagnóstico se hizo mediante TC. Se trató con antibioterapia de amplio espectro con buna penetración cerebral, con la que evolucionó a un aumento del tamaño del absceso y un empeoramiento clínico. Se realizó la aspiración estereotáxica de la lesión y la evolución fue favorable sin complicaciones postquirúrgicas (AU)

Brain abscess is uncommon but life- threatening infection in children with high mobility and mortality despite recent advances in diagnostic and therapeutic modalities. Predominant etiologic microorganisms vary depending on these predisposing factors. The clinical presentation in children can be nonspecific, and a high index of suspicion is required. Computed tomography (CT) and/or magnetic resonance imaging (MRI) are essential tools that enable the physician to diagnosis. Surgical drainage with antimicrobial therapy is the treatment of choice for most brain abscesses. In the early phase of cerebritis, infection can respond to long-term antibiotic therapy alone. We described a 13 years old girl with two brain abscesses originated form otitis media with antibiotic therapy. Diagnosis was given by CT. Initial treatment with broad spectrum antibiotics with good cerebral penetration was associated with an increase in the size of abscess and clinical worsening. Stereotactic aspiration of lesion and culture was performed and the patient showed improvement and there was any postoperative complication (AU)

Situación general y problemática de la varicela en España / No disponible

Se presenta un análisis epidemiológico de la varicela en España en los últimos años. Según el sistema de Enfermedades de Declaración Obligatoria (EDO) y la Red Nacional de Vigilancia Epidemiológica (RENAVE) la incidencia anual media de casos entre 1980 y 2000 es de aproximadamente 300.000. La mayoría se acumulan entre mayo y julio, describiéndose ciclos epidémicos cada 2 o 3 años. Según el último Conjunto Mínimo Básico de Datos (CMBD) de 1998, en este año se recogen 1.469 diagnósticos de varicela que requieren hospitalización (55,9 % varones y 44,1 % mujeres). La estancia media fue de 7 días. Las complicaciones más frecuentes fueron la neumonía hemorrágica en 246 casos y la encefalitis posvaricela en 55. La neumonía hemorrágica ocurrió en cerca del 80 % de los casos en mayores de 15 años y la encefalitis en el 22 % de los mayores de esta edad. La mayoría de casos ingresados corresponden a los menores de 5 años y a los de 25 a 34, siendo el porcentaje de casos complicados parecidos en ambos grupos de edad. En 1998 hubo 2 muertes en mujeres de 36 y 31 años, ambas con neumonía hemorrágica y dependencia tabáquica. Entre los años 1981 y 1997 se produjeron entre 3 y 6 defunciones por año. La encuesta de seroprevalencia de 1996 evidenció seropositividad en el 50 % de los niños de 2 a 5 años y en el 90-100 % de los de 15 a 19. Se hace notar que la cobertura vacunal mayor del 90 % hará que el impacto de la varicela disminuya en niños y adultos (AU)

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Epidemiology and economic impact of varicella in immunocompetent children in Spain. A nation-wide study.

The epidemiology and burden of varicella was assessed through the prospective study of 683 children under 15 years, by 58 primary care paediatricians working on seven autonomous communities of Spain. The mean age was 4.5+/-2.7 years, and 566 (83%) were secondary cases. There were 111 complications in 101 children (14.8%), skin superinfection being the most frequent (8.9%), followed by respiratory tract (4.5%) and eye (2.2%) infections. The mean number of visits to the paediatric clinic was 1.42 (95% C.I. 1.37-1.47), and 5.6% of the children were attended in the emergency department of a hospital previously. All children had at least one prescription, being antihistamines and antipyretics the most prescribed. Thirteen percent received systemic antibiotics and 11% acyclovir. Children were mainly cared by grandparents, and parents were off work for a mean of 0.97 days (1.61 if children under 5 years attended day-care facilities; 0.51 if they did not). Costs derived from medical attention totalled 32.5, and social indirect costs were 63.77.

Retirada de corticoides / Corticosteroid withdrawal

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Talla baja normal, adaptación psicosocial y salud / Low normal height, psychosocial adaptation and health

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Fine needle aspiration in the pre-operative diagnosis of melanotic neuroectodermal tumour of infancy.

A case of melanotic neuroectodermal tumour of infancy is described. The pre-operative diagnosis was made on cytological material obtained by fine needle aspiration. The patient was a three-month-old male infant with a rapidly growing maxillary tumour mass that also involved the pterygomaxillary fossae and the floor of the orbit. In addition to the typical clinical presentation, the cytology is also distinctive showing a dual population of small neuroblastic cells and large melanin-containing epithelial cells. Histological, immunohistochemical and electron microscopic examination of the excised mass confirmed the initial diagnosis. The pre-operative distinction of this tumour from other small round cell tumours of infancy (rhabdomyosarcoma, neuroblastoma, melanoma and lymphoma), is essential in order to plan the most complete resection therefore reducing the possibilities of tumour recurrence. This tumour belongs to a field of pathology with which many otolaryngologists may not be familiar.