Faringoamigdalitis y estreptococo, ¿enemigo o colonizador? / Tonsillopharyngitis and streptococcus, enemy or colonizer?

Introducción: la principal etiología de la faringoamigdalitis aguda (FAA) es vírica, y entre la bacteriana, Streptococcus pyogenes constituye un colonizador no despreciable de la población pediátrica sana. El objetivo del estudio es conocer el modo de utilización del test de diagnóstico rápido estreptocócico (TDR) en los servicios de urgencias pediátricas para poder optimizar su uso, reducir el sobrediagnóstico de las FAA estreptocócicas (FAAE) y la prescripción de antibióticos. Material y métodos: se recoge la información retrospectiva del número de TDR realizados a los pacientes atendidos en el servicio de urgencias pediátricas de un hospital terciario, desde enero de 2022 a enero de 2023 (ambos inclusive). También se ha recogido información acerca de a cuántos se les había practicado más de un TDR y el tiempo transcurrido. Resultados: durante los 13 meses estudiados se realizaron un total de 1610 TDR (43% en <5 años). Se realizó más de un TDR a 89 pacientes (53% en <5 años) y el 40% de estos se llevaron a cabo en los primeros 40 días. Discusión: las pruebas microbiológicas para detectar Streptococcus pyogenes no son capaces de diferenciar entre infección activa y estado de portador sano. Según los resultados de nuestro estudio parece existir un uso inadecuado de los TDR; la mayoría de las pruebas se realizan en <5 años, donde la etiología estreptocócica es menos frecuente y el estado de portador sano predominante. Esto conlleva un sobrediagnóstico de la FAAE, sobretratamiento antibiótico, aparición de efectos adversos y resistencias bacterianas. (AU)

Introduction: the most frequent aetiology of acute pharyngitis (AP) is viral, and among the bacterial causes, Streptococcus pyogenes is a colonizer that cannot be overlooked in the healthy paediatric population. The aim of the study was to determine how the rapid streptococcal diagnostic test (RST) is used in paediatric emergency departments in order to optimize its use and reduce the overdiagnosis of acute streptococcal pharyngitis (SP) and antibiotic prescribing. Material and methods: we collected retrospective data on the number of RSTs performed on patients managed in the paediatric emergency department of a tertiary care hospital between January 2022 and January 2023 (both included). We also collected data on the number of patients who underwent more than one RST and the time elapsed between tests. Results: during the 13-month study period, a total of 1610 RSTs were performed (43% in children < 5 years). More than one RST was performed in 89 patients (53% in children < 5 years), and 40% of additional tests were performed within 40 days of the previous one. Discussion: microbiological tests for S. pyogenes cannot differentiate between active infection and healthy carriage. Based on the findings of our study, there seems to be an inadequate use of RDTs; most tests are performed in children aged less than 5 years, in whom a streptococcal aetiology is less frequent and healthy carrier status predominates. This leads to overdiagnosis of acute SP, antibiotic overuse, adverse events and bacterial resistance. (AU)

Evidentia praxis: nirsevimab y prevención de bronquiolitis en lactantes nacidos a término / Evidentia praxis: Nirsevimab and bronchiolitis prevention in term-born infants

Analizamos la evidencia publicada sobre la eficacia y seguridad de nirsevimab, un anticuerpo monoclonal, empleado para prevenir las infecciones de vías respiratorias bajas (IVRB) por virus respiratorio sincitial (VRS) en el lactante a término. Encontramos un ensayo clínico aleatorizado controlado con placebo doble ciego que incluyó 3012 lactantes, nacidos a término o pretérmino tardío, menores de un año con un seguimiento de al menos 150 días. La calidad de la evidencia se clasificó como baja para IVRB muy grave y moderada para IVRB que precisara asistencia o ingreso. La evidencia se sustenta sobre un escaso número de eventos (para ingresos hospitalarios sólo 29 casos, para IVRB con atención médica 78), por lo que cualquier estimación debe considerarse imprecisa. La eficacia, estimada como reducción relativa del riesgo (RRR) fue del 76,4% (intervalo de confianza del 95% [IC 95]: 62,3 a 85,2) para IVRB por VRS y del 76,8% (IC 95: 49,4 a 89,4%) para ingreso. No se encontraron diferencias en cuanto a seguridad. Existen dudas sobre la importancia clínica, por los criterios de gravedad empleados, y sobre su impacto, con un número necesario a tratar para evitar una IVRB con ingreso de 63 y que requiera asistencia médica de 24. Por la información disponible parece una intervención segura, de la que no esperamos efectos adversos comunes, pero no podemos descartar efectos de baja frecuencia. Asimismo, esperamos contar pronto con estimaciones más precisas de eficacia y seguridad (AU)

We reviewed the published evidence on the efficacy and safety of nirsevimab, a monoclonal antibody, used to prevent respiratory syncytial virus (RSV) associated lower respiratory tract infections (LRTI) in term infants. We have found a randomized double-blind placebo-controlled clinical trial that included 3012 infants, born at term or late preterm, less than one year of age with a follow-up of at least 150 days. The quality of the evidence was classified as low for very severe LRTI and moderate for LRTI requiring medical care or admission. The evidence is based on a small number of events (only 29 cases for hospital admissions, 78 for IVRB with medical care), so any estimate must be considered imprecise. Efficacy, estimated as relative risk reduction (RRR) was 76.4% (95% confidence interval [95 CI]: 62.3 to 85.2) for RSV associated LRTI that required medical care and 76.8% (CI 95: 49.4 to 89.4%) for hospital admission. No differences were found in terms of safety. There are doubts about the clinical importance, due to the severity criteria used, and about its impact, with a number needed to treat of 63 to avoid a LRTI with hospital admission and of 24 to avoid LRTI requiring medical care. Based on the available information, it seems a safe intervention, from which we do not expect common adverse effects, but we cannot rule out low-frequency effects. We also expect to have more precise estimates of efficacy and safety soon. (AU)

COVID-19 en Pediatría: descripción clínica y microbiológica de los pacientes ingresados en un hospital terciario / COVID-19 in pediatrics: clinical and microbiological description of patients admitted to a tertiary hospital

Introducción: desde el inicio de la pandemia por el virus SARS-CoV-2 una de las grandes cuestiones que se ha formulado es qué papel desempeñan los niños en el control y manejo de la pandemia y cómo esta les ha afectado. Hay mucha bibliografía acerca de los síntomas y complicaciones que puede presentar esta población, pero poca de cómo ha sido el curso clínico de la infección en los niños ingresados en hospitales de tercer nivel y su impacto asistencial. Material y métodos: se han analizado descriptivamente las historias clínicas de los niños ingresados en el Hospital General Doctor Balmis de Alicante (España) desde enero de 2020 hasta julio de 2022. Se han analizado paralelamente los datos microbiológicos del SARS-CoV-2, variantes y linajes, desde agosto de 2021 hasta agosto de 2022. Resultados: se analizaron un total de 114 niños ingresados con diagnóstico de infección por SARS-CoV-2, de los cuales la mayoría tenían menos de 12 meses y eran de procedencia española. Los ingresos se distribuyeron de forma cronológica siguiendo un modelo de “olas”, siendo el motivo más frecuente la constatación del virus SARS-CoV-2 en las pruebas realizadas. El tratamiento que más frecuentemente recibieron durante el ingreso fueron los antibióticos orales. La mayor parte de los niños no tenían comorbilidades y no desarrollaron complicaciones. La variante mayoritaria fue ómicron y el linaje el BA.1. Discusión: los lactantes parecen ser más vulnerables a la infección por SARS-CoV-2 y las manifestaciones clínicas en este grupo de edad conllevan mayor probabilidad de ingreso. El desarrollo de complicaciones, necesidad de oxigenoterapia, ventilación mecánica e ingreso en UCI es mínimo en población pediátrica. El manejo de la infección difiere sustancialmente con el de los adultos, lo que se corresponde con tratamientos menos agresivos (AU)

Introduction: since the beginning of the SARS-CoV-2 pandemic, one of the main questions that has been asked is what role children play in the control and management of the pandemic and how it has affected them. There is much literature on the symptoms and complications that this population may have, but little on the clinical course of the infection in children admitted to tertiary hospitals and its impact on health care.Material and methods: the clinical histories of children admitted to the Hospital General Doctor Balmis (Alicante, Spain) from January 2020 to July 2022 were analyzed descriptively. At the same time, microbiological data on SARS-CoV-2, variants and lineages were analyzed from August 2021 to August 2022.Results: a total of 114 children admitted were analyzed, most of whom were younger than 12 months and from Spain. Admissions were distributed chronologically following a 'wave' pattern, the most frequent reason being the finding of SARS-CoV-2 virus in the tests performed. The most common treatment received during admission was oral antibiotics. Most of the children had no comorbidities and did not develop complications.Discussion: infants seem to be more vulnerable to SARS-CoV-2 infection, and clinical manifestations in this age group are more likely to lead to admission. The development of complications, need for oxygen therapy, mechanical ventilation and admission to the ICU is minimal in the pediatric population. The management of infection differs substantially from that of adults, which corresponds to less aggressive treatment. (AU)

Ondansetrón para el control de vómitos asociados a gastritis y gastroenteritis aguda en urgencias de Pediatría: uso, abuso y buen uso / Ondansetron for the control of vomiting associated with acute gastritis/gastroenteritis in Pediatric Emergencies: use, abuse and appropriate use

Introducción: el ondansetrón es un antiemético ampliamente utilizado en la práctica clínica para el control de vómitos asociados a gastritis y/o gastroenteritis aguda en niños. Sin embargo, la evidencia disponible es controvertida, sus indicaciones no están claramente definidas y no existe una unanimidad de uso en las guías de práctica clínica. Material y métodos: se realizó un estudio de cohortes retrospectivo en el que se incluyó un total de 825 niños entre 0 y 14 años con vómitos asociados a gastritis y/o gastroenteritis aguda que acudieron a Urgencias de Pediatría de un hospital terciario durante el año 2019. Se analizó la asociación entre el uso de ondansetrón y la necesidad de rehidratación intravenosa, las hospitalizaciones, el tiempo de permanencia en Urgencias y las nuevas consultas a Urgencias dentro de las 72 horas posteriores. Resultados: de la muestra estudiada, el 38,8% de los pacientes recibieron ondansetrón. La administración de ondansetrón redujo el riesgo de ingreso (OR 0,19; IC 95%: 0,04-0,84) y disminuyó el tiempo de permanencia en Urgencias (p = 0,000). No se encontraron diferencias significativas en la reducción de la necesidad de rehidratación intravenosa (OR 0,65; IC 95%: 0,40-1,05) ni en las nuevas visitas a Urgencias dentro de las 72 horas siguientes (OR 1,38; IC 95%: 0,82-2,31). Conclusiones: nuestros resultados sugieren que el uso de ondansetrón podría ser beneficioso en niños mayores de 6 meses con vómitos asociados a gastritis y/o gastroenteritis aguda y que presenten deshidratación de leve a moderada (AU)

Background: ondansetron is an antiemetic widely used in clinical practice for the control of vomiting associated with gastritis and/or acute gastroenteritis in children. However, the available evidence about its use is controversial, its directions for use are not clearly defined and there is no unanimity on its use in clinical practice guidelines.Methodology: we performed a retrospective cohort study which included a total of 825 children between 0 and 14 years, who presented symptoms of vomiting associated with gastritis and/or acute gastroenteritis and attended the Pediatric Emergency Department of a tertiary hospital in 2019. The association between the use of ondansetron and the need for intravenous rehydration, hospitalization, length of stay in the Pediatric Emergency Department and return visits to the emergency department within 72 hours was analysed.Results: of the sample studied, 38.7% of the patients received ondansetron. The administration of ondansetron reduced the risk of hospital admission (OR 0.19; 95% CI 0.04 to 0.84) and decreased the length of stay in the emergency department (p = 0.000). No significant differences were found in reducing the need for intravenous rehydration (OR 0.65; 95% CI 0.40 to 1.05) or in return visits to emergency department within 3 days (OR 1.38; 95% CI 0.82-2.31).Conclusions: our results suggest that the use of ondansetron could be beneficial in children older than 6 months with vomiting associated with gastritis and/or acute gastroenteritis and with mild-to-moderate dehydration. (AU)

COVID-19 como causa de hepatitis aguda / COVID-19 as a cause of acute hepatitis

En la patogenia del daño hepático agudo relacionado con la infección por SARS-CoV-2 se han realizado varias hipótesis: hepatotoxicidad de los fármacos en el tratamiento de la COVID-19; tormenta de citoquinas e hiperactivación inmune; daño hepático secundario a una situación de shock e hipoperfusión; y efecto citopático directo del virus Se presenta el caso de un niño de 10 años, previamente sano, que desarrolló una hepatitis aguda con patrón citolítico (ALT 1823 U/l y AST 1092 U/l), sin asociar aumento de otros parámetros de colestasis, y que, tras el estudio, únicamente se pudo atribuir a la COVID-19, dado que no recibió fármacos que pudiesen lesionar el hígado, ni presentó inestabilidad hemodinámica ni afectación de otros órganos o multiinflamatoria. El diagnóstico se pudo realizar tras exclusión de otras causas microbiológicas y gracias a la detección del virus tanto en el tracto respiratorio como en heces. Se realiza una discusión acerca del posible efecto citotóxico directo del virus y la bibliografía actual que respalda dicha hipótesis, así como de la practicidad de la detección por PCR del SARS-CoV-2 en heces para el diagnóstico de COVID-19 con afectación gastrointestinal o de predominio hepático (AU)

In the pathogenesis of acute liver damage related to SARS-CoV-2 infection, several hypotheses have been made: hepatotoxicity of drugs in the treatment of COVID-19; cytokine storm triggered by the immune hyperactivation; liver damage secondary to a situation of shock and hypoperfusion; and direct cytopathic effect of the virus.We repot the case of a previously healthy 10-year-old boy who, in December 2020, developed acute hepatitis with a cytolytic pattern (ALT 1823 U/L and AST 1092 U/L), without associated increase in other cholestatic parameters, and who after the study, it could only be attributed to COVID-19, since he did not receive drugs that could damage the liver, nor did he present hemodynamic instability or involvement of other organs or multi-inflammatory disease. The diagnosis was made after exclusion of other microbiological causes and thanks to the detection of the virus both in the respiratory tract and in feces. A discussion is made about the possible direct cytotoxic effect of the virus and the current literature that supports this hypothesis, as well as the practicality of PCR detection of SARS-CoV-2 in feces for the diagnosis of COVID-19 with gastrointestinal involvement or liver-predominant involvement. (AU)

The relevance of music therapy in paediatric and adolescent cancer patients: a scoping review.

BACKGROUND: Music therapy is an emerging and useful methodology to improve the quality of life of children and adolescents with cancer. OBJECTIVES: The objective of this scoping review was to examine the available literature and offer an analysis of the relevance of music therapy in paediatric oncology. We considered the effects of music therapy on children and adolescents with cancer as well as the perception of this population, their families, music therapists, and health professionals regarding the music therapy sessions conducted. Finally, we analysed the characteristics of the distinct types of music therapy interventions reported in the literature. METHODS: In this review, we applied the methodology proposed by Arksey and O'Malley. After performing a comprehensive academic literature database search, 522 articles were identified of which, 27 met the inclusion criteria. RESULTS: The results shed light on the use of music therapy as a means to facilitate self-esteem, to improve the physical, emotional, and cognitive aspects related to disease and, to a lesser extent, alleviate their physiological symptoms. Both children and adolescents with cancer were represented in the academic literature. The most prevalent findings described in these studies were the benefits of music therapy in terms of improved psychological well-being and social relationships in this population. CONCLUSIONS: Music therapy interventions are generally well received, not only by children and adolescents with cancer, but also by their families, music therapists, and health professionals. Nevertheless, several gaps were identified in some of the studies we considered, including a lack of specificity regarding the results obtained or music therapy intervention methods used.

Principales modificaciones en la guía de práctica clínica «COVID-19 en pediatría» / Main changes in the «COVID-19 in paediatrics» clinical practice guideline

Presentamos el resumen de las principales modificaciones surgidas en la guía de práctica clínica «COVID-19 en Pediatría» entre su versión inicial publicada en el año 2021 y la publicada en el año 2022. El documento se ha elaborado siguiendo los pasos estructurados de la medicina basada en la evidencia e incorporando el sistema GRADE para realizar síntesis de la evidencia, con valoración de su calidad y, cuando se consideró apropiado, emitir recomendaciones jerarquizadas (en función de la calidad de la evidencia, los valores y preferencias, el balance entre beneficios, riesgos y costes, la equidad y la factibilidad). En esta actualización se incluyen también los cambios recomendados por los revisores externos. Se sintetizan las principales modificaciones en los siguientes apartados: epidemiología, clínica, diagnóstico, prevención, tratamiento y vacunas. En el conjunto del conocimiento alcanzado a lo largo del primer año de pandemia, las publicaciones durante el segundo año añaden nuevos datos, sin que en muchas de las áreas se produzcan modificaciones sustanciales. Los principales cambios acaecen en el campo de investigación de las vacunas. Esta actualización finaliza en diciembre de 2021, coincidiendo con el aumento de la infección por ómicron, por lo que será necesario una futura actualización del documento.(AU)

We present a summary of the main modifications to the «COVID-19 in Paediatrics» clinical practice guideline made from its initial version, published in 2021, and the version published in 2022. The document was developed following the structured steps of evidence-based medicine and applying the GRADE system to synthesize the evidence, assess its quality and, when appropriate, issue graded recommendations (based on the quality of the evidence, values and preferences, the balance between benefits, risks and costs, equity and feasibility). This update also includes the modifications proposed by external reviewers.We summarised the main modifications in the following sections: epidemiology, clinical features, diagnosis, prevention, treatment and vaccines. In relation to the body of knowledge achieved in the first year of the pandemic, the literature published in the second year contributed additional data, but without substantial modifications in many of the areas. The main changes took place in the field of vaccine research. This update was completed in December 2021, coinciding with the emergence of infections by the omicron variant, so the document will need to be updated in the future. (AU)

Main changes in the "COVID-19 in paediatrics" clinical practice guideline.

We present a summary of the main modifications to the "COVID-19 in Paediatrics" clinical practice guideline made from its initial version, published in 2021, and the version published in 2022. The document was developed following the structured steps of evidence-based medicine and applying the GRADE system to synthesize the evidence, assess its quality and, when appropriate, issue graded recommendations (based on the quality of the evidence, values and preferences, the balance between benefits, risks and costs, equity and feasibility). This update also includes the modifications proposed by external reviewers. We summarised the main modifications in the following sections: epidemiology, clinical features, diagnosis, prevention, treatment and vaccines. In relation to the body of knowledge achieved in the first year of the pandemic, the literature published in the second year contributed additional data, but without substantial modifications in many the areas. The main changes took place in the field of vaccine research. This update was completed in December 2021, coinciding with the emergence of infections by the omicron variant, so the document will need to be updated in the future.

[Main changes in the «COVID-19 in paediatrics¼ clinical practice guideline]. / Principales modificaciones en la guía de práctica clínica «COVID-19 en pediatría¼.

We present a summary of the main modifications to the «COVID-19 in Paediatrics¼ clinical practice guideline made from its initial version, published in 2021, and the version published in 2022. The document was developed following the structured steps of evidence-based medicine and applying the GRADE system to synthesize the evidence, assess its quality and, when appropriate, issue graded recommendations (based on the quality of the evidence, values and preferences, the balance between benefits, risks and costs, equity and feasibility). This update also includes the modifications proposed by external reviewers.We summarised the main modifications in the following sections: epidemiology, clinical features, diagnosis, prevention, treatment and vaccines. In relation to the body of knowledge achieved in the first year of the pandemic, the literature published in the second year contributed additional data, but without substantial modifications in many of the areas. The main changes took place in the field of vaccine research. This update was completed in December 2021, coinciding with the emergence of infections by the omicron variant, so the document will need to be updated in the future.

Epidemias y pandemias: un viaje de Hipócrates a Hollywood / Epidemics and pandemics: a journey from Hippocrates to Hollywood

La Historia de la Medicina y los acontecimientos alrededor de las epidemias y pandemias deben servir para aprender de experiencias previas en momentos tan complicados. Las diez mayores pandemias de la Historia anteriores a la COVID-19 nos han dejado una serie de lecciones con cuatro protagonistas: al principio, Yersinia pestis, y luego tres virus (viruela, gripe y coronavirus). El cine nos permite el paso de la realidad a la ficción, y lo confirmamos al revisar veintisiete películas sobre epidemias y pandemias a lo largo de la historia del séptimo arte. De ellas, cabe "prescribir" seis películas argumentales: El doctor Arrowshmith (John Ford, 1931), Philadelphia (Jonathan Demme, 1993), Estallido (Wolfgang Petersen, 1995), 22 ángeles (Miguel Bardem, 2016), 93 días (Steve Gukas, 2016) y, especialmente, Contagio (Steven Soderbergh, 2011). En este viaje de Hipócrates a Hollywood (de la ciencia al arte), en el entorno de las epidemias y las pandemias, es posible adquirir algunas enseñanzas: 1) la historia nos demuestra dos realidades pasadas de las epidemias y pandemias: su gravedad y su recurrencia en el tiempo; 2) el cine nos revela dos supuestos futuros de las epidemias y las pandemias: su visión apocalíptica y su limitada positividad al ser reflejadas en la gran pantalla. De este modo, el cine actúa como una vacuna, pues nos expone en pequeñas dosis repetidas frente a las emociones y reflexiones que nos provocan las epidemias y pandemias; y ello con el fin de ganar en conocimiento, prudencia y resiliencia frente a esas entidades (AU)

The history of medicine and the events surrounding epidemics and pandemics should allow us to learn from previous experiences in such difficult times. The 10 largest pandemics in history prior to the coronavirus 2019 pandemic have left us a series of lessons with four main characters: earliest of all, Yersinia pestis, and then three viruses: smallpox, influenza and coronavirus.Filmmaking allow us to travel from reality to fiction, which we confirmed by reviewing 27 films about epidemics and pandemics throughout the history of the seventh art. Of these, six plot films can be "prescribed": Arrowsmith (John Ford, 1931), Philadelphia (Jonathan Demme, 1993), Outbreak (Wolfgang Petersen, 1995), 22 ángeles (Miguel Bardem, 2016), 93 days (Steve Gukas, 2016) and, especially, Contagion (Steven Soderbergh, 2011).In this journey from Hippocrates to Hollywood (from science to art) in the context of epidemics and pandemics, there are lessons to be gained: 1) History evinces two facts from previous epidemics and pandemics: that they are severe and that they recur over time; 2) Film shows us two future assumptions about epidemics and pandemics: an apocalyptic vision and a hardly positive perspective as reflected on the big screen. And this is how film acts as a vaccine, by exposing us in small and repeated doses to the emotions and reflections that epidemics and pandemics elicit in us, in pursuit of knowledge, prudence and resilience against these diseases. (AU)

A systematic review on pediatric medication errors by parents or caregivers at home.

INTRODUCTION: Medication errors (MEs) are frequent and, in some cases, can lead to hospitalization, disability, increased healthcare costs or, even, death. Most of pediatric medications are administered by parents or caregivers at home. It is necessary to explore the MEs at home to improve pediatric patient safety. AREAS COVERED: This study aimed to review the current literature on the frequency of pediatric MEs by parents or caregivers at home, their associated factors, and pediatric ME reporting systems. Citable original articles of any type of study design or reviews published from 2013 to 2021 were searched in Medline, Scopus, Embase, and ScienceDirect databases. EXPERT OPINION: The available data about the frequency of pediatric MEs at home varied from 30% to 80%. Current research suggests the risk of making a ME in pediatric patients at home may depend on the characteristics of the caregiver and may increase if a prescription contains ≥3 drugs. Findings conclude that providing dosing tools more closely matched to prescribed dose volumes, recommending the use of syringes as a measurement tool, and educational intervention for caregivers could be useful to reduce MEs. Concerning the reporting systems for pediatric MEs in the outpatient setting, no information was found.

Papel del pediatra en el manejo de las conductas disruptivas de la infancia / Role of the pediatrician in the management of disruptive behaviors in childhood

Es necesario reconocer, comprender y manejar la amplitud de cambios físicos, cognitivos y de comportamiento que se producen durante la edad pediátrica para garantizar el mejor estado de salud de los niños. Esta perspectiva compromete también la atención a aspectos conductuales que, aunque sean evolutivamente esperables, pueden comprometer la estabilidad del niño y la familia, e incluso dar lugar a trastornos psicopatológicos si no se abordan adecuadamente. Teniendo en cuenta que las familias confían y acuden en primera instancia al pediatra para que resuelva o encauce sus dudas sobre aspectos relacionados con la crianza, este articulo ofrece estrategias de manejo para las conductas disruptivas y las pataletas, basándonos en principios básicos de aprendizaje (AU)

Recognizing, understanding and managing the range of physical, cognitive and behavioral changes in the pediatric age is necessary to ensure the best health status for children. This perspective also compromises paying special attention to behavioral issues that, although developmentally expected, can compromise the stability of the child and family, and even lead to psychopathological disorders if they are not adequately issued. Bearing in mind that pediatricians are seen by families as the reference figure and that they expect him to solve their doubts about aspects related to upbringing, this article offers strategies about how to manage disruptive behaviors in young children, relying on basic learning principles (AU)

Pandemia por COVID-19 y su repercusión sobre las hospitalizaciones por bronquiolitis en el Centro y Este de España / Consequences of COVID-19 pandemic over acute bronchiolitis hospitalizations in the center and east of Spain

Introducción: Las intervenciones no farmacológicas puestas en marcha en territorios del hemisferio sur tras la declaración de la pandemia por COVID-19 en marzo de 2020, han puesto de manifiesto toda una serie de cambios inesperados en la propagación de otros virus. Dentro del proyecto Estudio Colaborativo Español para la Atención de Lactantes Hospitalizados por Bronquiolitis Aguda (ECEALHBA) presentamos este estudio cuyo objetivo ha sido constatar las repercusiones de la pandemia sobre la temporada epidémica de bronquiolitis de 2020 a 2021 en el centro y este de España. Material y métodos: Estudio multicéntrico, observacional, descriptivo y ambispectivo de una muestra de lactantes ingresados por bronquiolitis aguda en alguno de los 16 hospitales españoles participantes en la investigación. Se compararon desde el punto de vista cualitativo y cuantitativo las cinco temporadas epidémicas previas a la pandemia, de 2015 a 2020, con la última de 2020 a 2021. Resultados: Un total de 4.643 lactantes ingresaron en alguno de los hospitales participantes durante el periodo de estudio. Se describe un descenso porcentual de ingresos del 94,1% entre el periodo previo y la temporada epidémica coincidente con la pandemia. Septiembre pasó a ser el mes pico de ingresos en lugar de diciembre y enero como era habitual, con un descenso progresivo de los ingresos a partir de ese momento hasta el final del seguimiento en abril de 2021. El rinovirus, de forma atípica, ha sido el agente responsable de la mayoría de las bronquiolitis en esta última temporada de 2020 a 2021. (AU)

Introduction: Non-pharmaceutical interventions that have been implemented in southern hemisphere countries because of COVID-19 pandemic declaration in March 2020, have evidenced some unexpected changes in the way of spreading of many other viruses. This study as a part of ECEALHBA's Project, reports the consequences of COVID-19 pandemic over 2020–2021 bronchiolitis epidemic period in the Central and Eastern regions of Spain. Method: Multicenter, observational, descriptive and ambispective study of admitted infants with the diagnosis of bronchiolitis in 16 Spanish hospitals involved in the investigation project. Five epidemic periods previous to COVID-19 pandemic, from 2015 to 2020, were compared with the current one, 2020–2021, in both a qualitative and quantitative manner. Results: Total of 4643 infants were admitted to the participating hospitals along the study period. Pandemic season hospital admissions for bronchiolitis were 94.1% lower than in pre-pandemic period. December and January were peak months for bronchiolitis admissions during pre-pandemic period, but September was the peak month during pandemic year. There was a progressive decrease of admissions from this moment until the end of the follow up, in April 2021. Rhinovirus has been the commonest etiology for bronchiolitis in 2020–2021 epidemic period of bronchiolitis. (AU)

[Consequences of COVID-19 pandemic over acute bronchiolitis hospitalizations in the center and east of Spain]. / Pandemia por COVID-19 y su repercusión sobre las hospitalizaciones por bronquiolitis en el Centro y Este de España.

INTRODUCTION: Non-pharmaceutical interventions that have been implemented in southern hemisphere countries because of COVID-19 pandemic declaration in March 2020, have evidenced some unexpected changes in the way of spreading of many other viruses. This study as a part of ECEALHBA's Project, reports the consequences of COVID-19 pandemic over 2020-2021 bronchiolitis epidemic period in the Central and Eastern regions of Spain. METHOD: Multicenter, observational, descriptive and ambispective study of admitted infants with the diagnosis of bronchiolitis in 16 Spanish hospitals involved in the investigation project. Five epidemic periods previous to COVID-19 pandemic, from 2015 to 2020, were compared with the current one, 2020-2021, in both a qualitative and quantitative manner. RESULTS: Total of 4643 infants were admitted to the participating hospitals along the study period. Pandemic season hospital admissions for bronchiolitis were 94.1% lower than in pre-pandemic period. December and January were peak months for bronchiolitis admissions during pre-pandemic period, but September was the peak month during pandemic year. There was a progressive decrease of admissions from this moment until the end of the follow up, in April 2021. Rhinovirus has been the commonest etiology for bronchiolitis in 2020-2021 epidemic period of bronchiolitis. CONCLUSIONS: Some of the non-pharmaceutical interventions initiated because of COVID-19 pandemic are probably related to the dramatic decrease of bronchiolitis cases in 2020-2021 season. It would be rewarding to purpose novel research to clarify how these simple interventions can be useful, close to vaccines and antiviral drugs, to achieve the goal of avoiding the spread of respiratory viruses in pediatric population.

Cine y tabaco, el comienzo de una polémica amistad para el adolescente / Cinema and tobacco, the beginning of a controversial friendship for adolescents

El triángulo formado por tabaquismo, adolescencia y cine desarrolla una peligrosa amistad, una "violencia tabáquica" sobre la que no podemos desviar nuestra atención como pediatras. Las relaciones económicas entre la industria tabaquera y la industria cinematográfica permiten un marketing encubierto, complejo, omnipresente, difícil de evidenciar y más de denunciar, con modalidades como la publicidad por emplazamiento y el posicionamiento de marca. Se aprende a fumar, entre otras causas, con las películas y series de televisión y ello oscila desde el predominante cine con tabaco a lo largo de su historia, al escaso cine contra el tabaco, pasando por aquellas películas que tienen el tabaco como leitmotiv. Hay que tener en cuenta que, al inicio del tabaquismo, seducir y atraer es lo que importa y de esto se encarga en ocasiones los medios audiovisuales del entretenimiento; luego, la nicotina rubrica el enlace que en muchas ocasiones llega "hasta que la muerte los separe". Son numerosas las instituciones (comenzando con la Organización Mundial de la Salud [OMS] y la Organización Panamericana de la Salud [OPS]) y grupos de trabajo que abogan por pasar de la evidencia a la acción en las normas y legislación de las películas sin tabaco, como una medida de salud pública. También nuestro grupo de trabajo, y como colofón del II Curso Nacional de Tabaquismo en Pediatría realizado el año 2019, ha elaborado el Documento de compromiso para mejorar el control del tabaquismo en medios audiovisuales. El siglo XXI debe caminar hacia un séptimo arte "sin malos humos". Y todo recurso es válido, desde las políticas gubernamentales y políticas sanitarias en primer término, a cualquier otra medida de apoyo y concienciación ciudadana frente a esta práctica

The triangle formed by smoking, adolescence and cinema develops a dangerous friendship, a "smoking violence" on which we cannot look away as pediatricians. The relationships between the tobacco industry and the film industry allow a covert, complex, omnipresent marketing, difficult to evidence and to report, with modalities such as product placement and brand positioning. You learn to smoke, between other ways, with movies and television series and this oscillates from the predominant cinema with tobacco throughout its history, to scarce anti-tobacco cinema, passing through those films that have tobacco as their leitmotif. Keep in mind that at the beginning of smoking, seducing and attracting is what matters and this is sometimes commissions audiovisual media for entertainment; then, nicotine initiates the link that on many occasions arrives "until death separates them". There are numerous institutions (starting with WHO and PAHO) and working groups that advocate moving from evidence to action in tobacco-free film standards and legislation, as a measure of public health. Also our working group, and as a culmination of the II National Course on Smoking in Pediatrics held in 2019, has prepared the Commitment document to improve control of smoking in audiovisual media. The XXI century must walk towards a seventh art "without bad fumes." And every resource is valid, from government policies and health policies in the first place, to any other measure of citizen support and awareness of this practice

Gender inequalities on editorial boards of indexed pediatrics journals.

BACKGROUND: The presence of women in decision-making positions, such as on editorial committees of biomedical journals, is not the same as that of men. This paper analyzes the gender composition of editorial committees (EBMs) and editors-in-chief (ECs) positions of pediatric journals. METHODS: The gender of EBMs and ECs of 125 journals classified in the pediatrics area of the Journal Citation Report (JCR) was analyzed. The following indicators were calculated: gender distribution of ECs and EBMs by journal, publisher, subject speciality, country, quartile of the journal in JCR and country of affiliation of the members. RESULTS: The total number of EBMs was 4242. The distribution by sex of the ECs was 19.44% women and 80.56% men, while that of the EBMs were 33.05% women and 66.95% men. Twenty journals exhibited a greater representation of women than of men, and in four there was parity. Journals with greater participation of women specialized in nursing and physical therapy and were related to nutrition (lactation and breastfeeding). CONCLUSIONS: Only one-fifth of ECs and one-third of EBMs are females. Women's participation is higher in journals related to nursing, physical and occupational therapy, and nutrition. The United States has the highest number of EBMs, followed by the European Union. IMPACT: Only one-fifth of Editors-in-chief in pediatrics journals are female. Only one-third of Editorial Board Members in pediatrics journals are female. Women's participation is higher in editorials committees in pediatrics journals related to nursing, physical and occupational therapy, and nutrition. Medical and pediatric associations and societies must work together to eliminate the disparities that exist between women and men. Achieving gender equity and empowering all women is one of the World Health Organization's Sustainable Development Goals.

Los trastornos del neurodesarrollo son "de cine"... y quedan muchos guiones por escribir / Neurodevelopmental disorders are "from cinema"... and there are many scripts to write

Los trastornos del neurodesarrollo, como el autismo, aunque presentes principalmente en la infancia, son una afección de por vida. Uno de los principales retos en el campo de los trastornos del neurodesarrollo es que estas entidades se hagan visibles. Y un terreno esencial para trabajar por su visualización son los medios de comunicación, siendo el cine un recurso esencial. El proyecto Cine y Pediatría apuesta por el objetivo de mejorar la humanización de nuestra práctica clínica a través de la prescripción de películas. Y en este artículo proponemos 22 películas sobre trastornos del neurodesarrollo en la infancia y adolescencia para vivir las emociones y reflexiones que nos devuelven sus protagonistas y familias. Estas son las películas prescritas que abordan el trastorno del espectro autista: Mater amatísima, Rain Man, Paraíso oceánico, Un viaje inesperado, Mozart y la ballena, Ben-X, El niño de Marte, Mary and Max, María y yo, Mi nombre es Khan, Tan fuerte, tan cerca, La sonrisa verdadera, Especiales. Y estas son las películas prescritas que versan sobre otros trastornos del neurodesarrollo: El milagro de Anna Sullivan, Forrest Gump, Estrellas en la Tierra, El primero de la clase, Gabrielle, Cromosoma 5, La historia de Marie Heurtin, Línea de meta, Dora y la revolución sexual. La observación narrativa de estas películas argumentales nos permitirá acercarnos a este apasionante mundo, pero sobre todo a las extraordinarias personas y familias que hay detrás del frío nombre de cada entidad médica. Y aunque hemos "prescrito" 22 historias "de cine", seguro que en los trastornos del neurodesarrollo quedan muchos guiones por escribir

Neurodevelopmental disorders such as autism spectrum disorder, although most commonly present in childhood, can be lifelong conditions. One of the main challenges in the field of neurodevelopmental disorders is that these entities become visible. For that purpose, media is playing a relevant role in order to achieve such a challenge, and cinema is one of the essentials. Cine y Pediatría project aims to improve the humanization of our clinical practice through the prescription of films. In this article we propose 22 films whose protagonists are children or adolescents with neurodevelopment disorders, essential to experience the emotions and reflections that their heroes and families give us back. These are the prescribed movies regarding autism spectrum disorder: Mater amatísima, Rain Man, Ocean Heaven, Miracle Run, Mozart and the Whale, Ben-X, Martian Child, Mary and Max, María y yo, My name is Khan, Extremely Loud and Incredibly Closer, La sonrisa verdadera and Hors normes. And these are the prescribed movies regarding other neurodevelopmental disorders: The Miracle Worker, Forrest Gump, Taare Zameen Par, Front of the class, Gabrielle, Cromosoma 5, Marie Heurtin, Línea de meta and Dora or The Sexual Neuroses of Our Parents. The narrative observation of these main plot films will allow us to approach this exciting world, but above all the extraordinary people and families behind the cold name of each medical entity. And although we have "prescribed" 22 "cinema" stories, surely in neurodevelopmental disorders there are many scripts to write

Impacto científico y contextualización bibliométrica de la Pediatría respecto a otras áreas temáticas / Scientific impact and bibliometric contextualisation of Paediatrics compared to other specialities

INTRODUCCIÓN: El objetivo de este trabajo es doble. Por una parte, identificar y caracterizar los indicadores de producción, citación, impacto y colaboración del área Pediatrics del Journal Citation Reports, y por otra, estudiar a la revista Anales de Pediatría en el contexto de las revistas españolas de otras 20 áreas y especialidades médicas. MATERIAL Y MÉTODO: Las fuentes de información utilizadas para la obtención de los indicadores fueron Science Citation Index-Expanded, Journal Citation Reports y Scimago Journal & Country Rank. Se realizó un análisis de regresión para comprobar la correlación entre la citación y otras variables. RESULTADOS: Pediatrics ocupó el 8.o lugar en producción científica durante la década 2009-2018. En citas por revista se sitúa en el puesto 17.o y la media de citas por artículo se acerca a las 27, ocupando en este caso el puesto 18.o. Por debajo de Pediatrics se sitúan Emergency Medicine, Rehabilitation y Primary Health Care. El 12,47% de los artículos no fueron citados. El factor de impacto medio la sitúa en el puesto 18.o y su índice h fue 197, alcanzando la posición 14.a y situándose por encima de otras 7 áreas. El porcentaje de trabajos realizados en colaboración internacional fue del 17,71%, por encima de Primary Health Care (12,88%), Oncology (16,37%) y Emergency Medicine (17,03%). Entre las revistas españolas, Anales de Pediatría fue la cuarta revista más productiva y en número de citas ocupó una posición intermedia. CONCLUSIONES: Los indicadores de citación e impacto del área Pediatrics suelen situarse por encima de áreas como Emergency Medicine, Primary Health Care, Dentistry, Oral Surgery & Medicine y Rehabilitation. El ejercicio profesional fuera de los grandes centros hospitalarios, unido a la deficiente financiación y al escaso número de ensayos clínicos debido a las exigencias éticas impuestas a los estudios con población infantil, pueden ser las causas que provocan unos indicadores de citación e impacto moderados

INTRODUCTION: The purpose of this paper is twofold. On the one hand, to identify and characterise the production, citation, impact and collaboration indicators of the Pediatrics area of the Journal Citation Reports, and on the other hand, to place the journal Anales de Pediatría in the context of the Spanish journals of another twenty areas and medical specialties. MATERIAL AND METHOD: The sources of information used to obtain the indicators were Science Citation Index-Expanded, Journal Citation Reports, and Scimago Journal & Country Rank. A regression analysis was performed to determine the correlation between the citation and other variables. RESULTS: Pediatrics ranked 8th in scientific production during the period 2009-2018. In citations per journal it ranks 17th, and the average citations per article approaches 27, occupying, in this case, the 18th position. Below Pediatrics are Emergency Medicine, Rehabilitation, and Primary Health Care. There are no citations for 12.47% of the articles. The average impact factor places the area in 18th place and its h index was 197, reaching 14th position, and standing above seven other areas. The percentage of works carried out with international collaboration was 17.71%, above Primary Health Care (12.88%), Oncology (16.37%), and Emergency Medicine (17.03%). Among the Spanish journals, Anales de Pediatría was the fourth most productive journal, and occupied an intermediate position in terms of the number of citations. CONCLUSIONS: The indicators of citation and impact of the Pediatrics area tend to be above areas such as Emergency Medicine, Primary Health Care, Dentistry, Oral Surgery & Medicine, and Rehabilitation. Professional practice outside large hospitals, together with poor funding, as well as the low number of clinical trials due to the ethical requirements imposed on studies with children, may be the causes that result in moderate citation and impact indicators

[Scientific impact and bibliometric contextualisation of Paediatrics compared to other specialities]. / Impacto científico y contextualización bibliométrica de la Pediatría respecto a otras áreas temáticas.

INTRODUCTION: The purpose of this paper is twofold. On the one hand, to identify and characterise the production, citation, impact and collaboration indicators of the Pediatrics area of the Journal Citation Reports, and on the other hand, to place the journal Anales de Pediatría in the context of the Spanish journals of another twenty areas and medical specialties. MATERIAL AND METHOD: The sources of information used to obtain the indicators were Science Citation Index-Expanded, Journal Citation Reports, and Scimago Journal & Country Rank. A regression analysis was performed to determine the correlation between the citation and other variables. RESULTS: Pediatrics ranked 8th in scientific production during the period 2009-2018. In citations per journal it ranks 17th, and the average citations per article approaches 27, occupying, in this case, the 18th position. Below Pediatrics are Emergency Medicine, Rehabilitation, and Primary Health Care. There are no citations for 12.47% of the articles. The average impact factor places the area in 18th place and its h index was 197, reaching 14th position, and standing above seven other areas. The percentage of works carried out with international collaboration was 17.71%, above Primary Health Care (12.88%), Oncology (16.37%), and Emergency Medicine (17.03%). Among the Spanish journals, Anales de Pediatría was the fourth most productive journal, and occupied an intermediate position in terms of the number of citations. CONCLUSIONS: The indicators of citation and impact of the Pediatrics area tend to be above areas such as Emergency Medicine, Primary Health Care, Dentistry, Oral Surgery & Medicine, and Rehabilitation. Professional practice outside large hospitals, together with poor funding, as well as the low number of clinical trials due to the ethical requirements imposed on studies with children, may be the causes that result in moderate citation and impact indicators.

«Preparo Mi Rotación Por», complemento virtual de la formación MIR en Pediatría / «I Prepare My Rotation By», a virtual complement of paediatric specialist training

La Asociación Española de Pediatría (AEP) tiene entre sus objetivos desarrollar actividades encaminadas a la formación de sus socios. Así, en 2013 puso en marcha su proyecto formativo más ambicioso, la plataforma de formación virtual «Continuum». Se presenta ahora una nueva sección dirigida a los médicos internos residentes (MIR) en Pediatría y a sus tutores: «Preparo Mi Rotación Por» (PMRP), que tiene como propósitos disminuir la variabilidad en la formación de los MIR, asistir a los tutores en su función docente, facilitar el aprendizaje colaborativo y basado en competencias, el entrenamiento reflexivo y la resolución de problemas propios del perfil profesional de cada especialidad pediátrica. PMRP se distribuye en tres secciones principales: «De dónde partimos» (con las subsecciones: cuestionario de autoevaluación y contrato de aprendizaje), «Situaciones a resolver» (donde se desglosan los escenarios clínicos que han sido escogidos en el contrato de aprendizaje) y «A dónde llegamos» (que vuelve a incluir las subsecciones del comienzo de la rotación, para comprobar si los objetivos previstos han sido alcanzados, y el informe de evaluación). Además, cuenta con otros recursos: conocimientos previos, porfolio y foro de debate. Cabe destacar cinco aspectos del modelo formativo propuesto en esta nueva sección: el escenario clínico como punto de partida; el aprendizaje basado en competencias (fundamentado en el Global Pediatric Educational Consortium); la evaluación como estímulo de formación; el poder del aprendizaje colaborativo, y la participación de las diferentes sociedades de especialidad de la AEP en el desarrollo de sus contenidos

The Spanish Paediatric Association (AEP) has, among its objectives, to develop activities aimed at the training of its members. Thus, in 2013, it began its most ambitious training project, the virtual platform, «Continuum». Now it presents a new section aimed at Internal Medicine Residents (MIR) in Paediatrics and their tutors: «I Prepare My Rotation By» (PMRP), which has as objectives to reduce the variation in MIR training, to help the tutors in their teaching function, to facilitate collaborative and skill-based learning, reflective training, and the resolving of the particular problems of the professional profile of each paediatric speciality. PMRP is split into three main sections: «From where do we start» (with the sub-sections: self-assessment questionnaire and learning agreement), «Situations to resolve» (where the clinical scenarios that have been selected in the learning agreement are broken down), and «To where have we got» (which includes again the sub-sections at the beginning of the rotation in order to check if the expected objectives have been reached, and the assessment report). It also has other resources: prior knowledge, portfolio, and discussion forum. Five features of the proposed training model should be highlighted: the clinical scenario as a starting point; skill-based learning (based on the Global Paediatric Educational Consortium); the assessment as a training stimulus; the power of collaborative learning, and the participation of the different specialist societies of the AEP in the development of its contents