Transition of Adolescents With Severe Asthma From Pediatric to Adult Care in Spain: The STAR Consensus.

OBJECTIVES: To assess the degree of consensus among a multidisciplinary expert panel on the transition of adolescents with severe asthma from pediatric to adult care. METHODS: A 61-item survey was developed based on guidelines for other chronic diseases, covering transition planning, preparation, effective transfer, and follow-up. A 2-round Delphi process assessed the degree of consensus among 98 experts (49 pediatricians, 24 allergists, and 25 pulmonologists). Consensus was established with ≥70% agreement. RESULTS: Consensus was reached for 42 items (70%). Panelists were unable to agree on an age range for initiation of transition. The main goal during the transition identified by the experts is for adolescents to gain autonomy in managing severe asthma and prescribed treatments. The panelists agreed on the importance of developing an individualized plan, promoting patient autonomy, and identifying factors associated with the home environment. They agreed that the adult health care team should have expertise in severe asthma, biologics, and management of adolescent patients. Pediatric and adult health care teams should share clinical information, agree on the criteria for maintaining biological therapy, and have an on-site joint visit with the patient before the effective transfer. Adult health care professionals should closely follow the patient after the effective transfer to ensure correct inhaler technique, adherence, and attendance at health care appointments. CONCLUSION: This consensus document provides the first roadmap for Spanish pediatric and adult teams to ensure that key aspects of the transition process in severe asthma are covered. The implementation of these recommendations will improve the quality of care offered to the patient.

Transition of Adolescents With Severe Asthma From Pediatric to Adult Care in Spain: The STAR Consensus

Objective: To assess the degree of consensus among a multidisciplinary expert panel on the transition of adolescents with severe asthma from pediatric to adult care. Methods: A 61-item survey was developed based on guidelines for other chronic diseases, covering transition planning, preparation, effective transfer, and follow-up. A 2-round Delphi process assessed the degree of consensus among 98 experts (49 pediatricians, 24 allergists, and 25 pulmonologists). Consensus was established with ≥70% agreement. Results: Consensus was reached for 42 items (70%). Panelists were unable to agree on an age range for initiation of transition. The main goal during the transition identified by the experts is for adolescents to gain autonomy in managing severe asthma and prescribed treatments. The panelists agreed on the importance of developing an individualized plan, promoting patient autonomy, and identifying factors associated with the home environment. They agreed that the adult health care team should have expertise in severe asthma, biologics, and management of adolescent patients. Pediatric and adult health care teams should share clinical information, agree on the criteria for maintaining biological therapy, and have an on-site joint visit with the patient before the effective transfer. Adult health care professionals should closely follow the patient after the effective transfer to ensure correct inhaler technique, adherence, and attendance at health care appointments. Conclusions: This consensus document provides the first roadmap for Spanish pediatric and adult teams to ensure that key aspects of the transition process in severe asthma are covered. The implementation of these recommendations will improve the quality of care offered to the patient (AU)

Objetivo: Evaluar el grado de consenso con un panel multidisciplinar de expertos sobre la transición del adolescente con asma grave de los servicios de pediatría a atención de adultos. Métodos: Se elaboró un cuestionario de 61 ítems basado en recomendaciones de transición para otras patologías crónicas, abarcando la planificación de la transición, preparación, transferencia efectiva y seguimiento. Se evaluó el nivel de consenso entre 98 expertos (49 pediatras, 24 alergólogos y 25 neumólogos) mediante un proceso Delphi de dos rondas. El consenso se estableció con un acuerdo ≥70%. Resultados: Cuarenta y dos ítems (70%) alcanzaron consenso. Los panelistas no alcanzaron consenso en el rango de edad para iniciar la transición. El principal objetivo a conseguir durante la transición según los expertos fue que el adolescente gane autonomía en el manejodel asma grave y tratamientos prescritos. Asimismo, alcanzaron acuerdo en la importancia de desarrollar un plan individualizado, promover la autonomía del paciente e identificar los factores clave en el entorno familiar. Los especialistas de adultos deben tener experiencia en asma grave y tratamientos biológicos, así como en el manejo de pacientes adolescentes. Los equipos sanitarios de pediatría y de adultos deben compartir la información clínica, consensuar los criterios para mantener la terapia biológica y realizar una visita conjunta con el paciente antes de la transferencia. Los especialistas de adultos deben realizar un seguimiento estrecho del paciente tras la transferencia para asegurar una correcta técnica inhalatoria, el cumplimiento del tratamiento y la asistencia a las citas sanitarias. Conclusiones: Este documento de consenso proporciona la primera hoja de ruta en España para que los equipos especialistas de pediatría y adultos garanticen aspectos clave del proceso de transición en pacientes adolescentes con asma grave. La aplicación de estas (AU)

Reacciones de hipersensibilidad a antiinflamatorios no esteroideos y su tolerancia a fármacos alternativos / Hypersensitivity reactions to non-steroidal anti-inflammatory drugs and tolerance to alternative drugs

INTRODUCCIÓN: Las reacciones de hipersensibilidad (HS) a los antiinflamatorios no esteroideos (AINE) son las reacciones a drogas más frecuentes. Su prevalencia en la población general varía del 0,6 al 5,7%, no teniendo datos en niños. El objetivo de este estudio fue determinar la frecuencia de pacientes diagnosticados de HS a AINE, características clínicas, tipo de HS y tolerancia a fármacos alternativos. MATERIAL Y MÉTODOS: Estudio descriptivo retrospectivo de niños con sospecha de HS a AINE realizado entre enero de 2012 y diciembre de 2013. El diagnóstico se realizó mediante prueba de exposición controlada (PEC) al fármaco implicado cuando tenían historia de episodio único, y basado en la clínica si había habido más de un episodio con un mismo fármaco. Posteriormente se realizó una PEC al ácido acetilsalicílico, para diferenciar en HS selectiva o múltiple. En los casos con resultado positivo se hizo una PEC a fármacos alternativos. RESULTADOS: Se estudiaron 93 niños, de los que 26 fueron diagnosticados de HS a AINE (7 confirmados mediante PEC y 19 basados en la clínica). Un 50% presentó HS múltiple. El ibuprofeno estuvo involucrado en todas las reacciones. La clínica observada con mayor frecuencia en la PEC fue el angioedema (44%). El paracetamol fue el fármaco alternativo mejor tolerado. CONCLUSIONES: Un 28% de la población estudiada fue diagnosticada de HS a AINE, y el 50% presentó una HS múltiple. El paracetamol es una alternativa segura en niños con HS a AINE. El meloxicam podría considerarse como una alternativa en los casos que no toleran el paracetamol

INTRODUCTION: Hypersensitivity reactions to non-steroidal anti-inflammatory drugs (NSAIDs) are the most common reactions to drugs. The prevalence varies from 0.6 to 5.7% in general population, but there are no data available in children. The aim of this study is to determine the frequency of patients diagnosed with hypersensitivity to NSAIDs, and describe their clinical characteristics, type of hypersensitivity, and tolerance to alternative drugs. METHODS: Retrospective study was conducted on children with suspected hypersensitivity to NSAIDs from January 2012 to December 2013. The diagnosis was confirmed by oral drug provocation test (DPT) to the drug involved in the group with a history of one episode, while in the group with a history of more than one episode with the same drug the diagnosis was based on clinical data. Subsequently, a DPT with acetylsalicylic acid (ASA) was done in order to classify hypersensitivity into selective or multiple. In those cases with a positive result, a DPT was performed with alternative drugs. RESULTS: Out of a total of 93 children studied, 26 were diagnosed with hypersensitivity to NSAIDs: 7 confirmed by oral DPT, and 19 based on clinical data. Multiple hypersensitivity was diagnosed in 50% of patients. Ibuprofen was involved in all reactions. The most common clinical manifestation was angioedema (44%). Acetaminophen was the best tolerated alternative drug. CONCLUSIONS: More than one quarter (28%) of the population studied was diagnosed with hypersensitivity to NSAIDs, and 50% had multiple hypersensitivity. Acetaminophen is a safe alternative in children with hypersensitivity to NSAIDs. Meloxicam may be an alternative in cases that do not tolerate acetaminophen

[Hypersensitivity reactions to non-steroidal anti-inflammatory drugs and tolerance to alternative drugs]. / Reacciones de hipersensibilidad a antiinflamatorios no esteroideos y su tolerancia a fármacos alternativos.

INTRODUCTION: Hypersensitivity reactions to non-steroidal anti-inflammatory drugs (NSAIDs) are the most common reactions to drugs. The prevalence varies from 0.6 to 5.7% in general population, but there are no data available in children. The aim of this study is to determine the frequency of patients diagnosed with hypersensitivity to NSAIDs, and describe their clinical characteristics, type of hypersensitivity, and tolerance to alternative drugs. METHODS: Retrospective study was conducted on children with suspected hypersensitivity to NSAIDs from January 2012 to December 2013. The diagnosis was confirmed by oral drug provocation test (DPT) to the drug involved in the group with a history of one episode, while in the group with a history of more than one episode with the same drug the diagnosis was based on clinical data. Subsequently, a DPT with acetylsalicylic acid (ASA) was done in order to classify hypersensitivity into selective or multiple. In those cases with a positive result, a DPT was performed with alternative drugs. RESULTS: Out of a total of 93 children studied, 26 were diagnosed with hypersensitivity to NSAIDs: 7 confirmed by oral DPT, and 19 based on clinical data. Multiple hypersensitivity was diagnosed in 50% of patients. Ibuprofen was involved in all reactions. The most common clinical manifestation was angioedema (44%). Acetaminophen was the best tolerated alternative drug. CONCLUSIONS: More than one quarter (28%) of the population studied was diagnosed with hypersensitivity to NSAIDs, and 50% had multiple hypersensitivity. Acetaminophen is a safe alternative in children with hypersensitivity to NSAIDs. Meloxicam may be an alternative in cases that do not tolerate acetaminophen.

A 10% liquid immunoglobulin preparation for intravenous use (Privigen (R)) in paediatric patients with primary immunodeficiencies and hypersensitivity to IVIG

BACKGROUND: The objective of this study was to evaluate safety and efficacy of Privigen®, a 10% intravenous immunoglobulin (IVIG), in a particular group of paediatric patients (highly sensitive to previous IVIG infusion) affected with Primary Immunodeficiencies (PID). MATERIAL AND METHODS: Patients (n = 8) from 3 to 17 years old diagnosed of PID who often suffered from adverse events related to the infusion to previous IVIG were switched to Privigen® in an open protocol. Data were prospectively collected regarding Privigen® administration: infusion, safety and efficacy. In parallel, data on safety and tolerance were retrospectively collected from medical charts regarding the previous 10% IVIG product used. RESULTS: 50% of the patients required premedication with previous IVIG. At the end of the study none required premedication with Privigen®. The infusion rate was lower than that recommended by the manufacturer. All patients had suffered through adverse events during previous IVIG infusion being severe in three patients and recurrent in the rest. With Privigen® only three patients suffered from an adverse event (all cases were milder than previous related). Trough levels of IgG remained stable. None suffer from any episode of bacterial infection. CONCLUSION: The present work shows that Privigen® was safe in a group of hypersensitive paediatric patients who did not tolerate the administration of a previous 10% liquid IVIG by using a particular infusion protocol slower than recommended. The number of adverse effects was smaller than published, and all cases were mild. No premedication was needed. Privigen® was also effective in this small group

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A 10% liquid immunoglobulin preparation for intravenous use (Privigen®) in paediatric patients with primary immunodeficiencies and hypersensitivity to IVIG.

BACKGROUND: The objective of this study was to evaluate safety and efficacy of Privigen®, a 10% intravenous immunoglobulin (IVIG), in a particular group of paediatric patients (highly sensitive to previous IVIG infusion) affected with Primary Immunodeficiencies (PID). MATERIAL AND METHODS: Patients (n=8) from 3 to 17 years old diagnosed of PID who often suffered from adverse events related to the infusion to previous IVIG were switched to Privigen® in an open protocol. Data were prospectively collected regarding Privigen® administration: infusion, safety and efficacy. In parallel, data on safety and tolerance were retrospectively collected from medical charts regarding the previous 10% IVIG product used. RESULTS: 50% of the patients required premedication with previous IVIG. At the end of the study none required premedication with Privigen®. The infusion rate was lower than that recommended by the manufacturer. All patients had suffered through adverse events during previous IVIG infusion being severe in three patients and recurrent in the rest. With Privigen® only three patients suffered from an adverse event (all cases were milder than previous related). Trough levels of IgG remained stable. None suffer from any episode of bacterial infection. CONCLUSION: The present work shows that Privigen® was safe in a group of hypersensitive paediatric patients who did not tolerate the administration of a previous 10% liquid IVIG by using a particular infusion protocol slower than recommended. The number of adverse effects was smaller than published, and all cases were mild. No premedication was needed. Privigen® was also effective in this small group.

[Treatment of the dysfunction of the pelvic floor]. / Tratamiento de la disfunción del suelo pélvico.

The perineum is formed by muscle-aponeurotic elements that are integrated under the control of the nervous system. Their alterations are responsible for urogynecological, coloproctologic and sexual pathologies. In order to obtain a successful treatment, it is obliged not to forget the role that plays the perineum in those pathologies. The treatment of the dysfunction of the pelvic floor groups conservative techniques and procedures like changes in life habits, behavioural therapy, biofeedback, electroestimulation (neuromodulation and peripheral electrical stimulation) and training with muscular exercises of the pelvic floor (perineal rehabilitation). The objective of all of them is to improve or to obtain the urinary continence, the strengthening of its musculature to be able to balance pelvic static, to improve the local vascularization and the anorrectal function besides securing a satisfactory sexuality.

[Perinatal outcomes in immigrant women]. / Resultados perinatales de las gestantes inmigrantes.

OBJECTIVES: To describe the characteristics of immigrant women's newborns in our environment, and to compare them with those of native women's newborns. PATIENTS AND METHODS: All newborns attended in the Neonatology Section of Hospital del Mar in Barcelona, Spain, in 2003 and 2004 were included (n 5 2,735). Data were prospectively collected in a database. Pregnant immigrant women were classified in 6 regions (Eastern Europe, the rest of Europe, Africa, Asia, Latin America and other countries). Twelve diagnoses were defined and compared between native newborns and those of immigrant parents, and their relative risks were calculated. RESULTS: There were 1,296 native newborns (47.8 %) and 1,416 of immigrant origin (52.2 %). Immigrant women showed a higher rate of HBsAg carrier status (2.0 % versus 1.0 %) and a lower rate of hepatitis C virus infection (0.8 % vs 2.0 %; p < 0.01). There was only one HIV-positive pregnant immigrant woman compared with 14 Spanish women (p < 0.01), and drug use was lower in the immigrant group (0.4 % vs 4.0 %; p < 0.01). Immigrant newborns had a lower rate of prematurity (6.0 % vs 7.6 %) and of low birthweight (2.3 % vs 4.6 %; p < 0.01). There were no significant differences in the rate of respiratory distress or fetal acidosis. The incidence of neonatal infection risk was higher in immigrant newborns (49.9 % vs 40.6 %; p < 0.01). CONCLUSIONS: In our environment, immigrant mothers' newborns have better perinatal outcomes than native newborns. The most frequent complications are secondary to an inadequate.

Resultados perinatales de las gestantes inmigrantes / Perinatal outcomes in immigrant women

Objetivos Conocer las características de los recién nacidos de las gestantes inmigrantes atendidas en nuestro medio y compararlas con las de los recién nacidos de madre autóctona. Pacientes y métodos Se incluyen los recién nacidos atendidos en la Sección de Neonatología del Hospital del Mar de Barcelona en los años 2003 y 2004 (n 5 2.735). Los datos eran recogidos de forma prospectiva en una base de datos. Las gestantes inmigrantes se clasificaron en 6 regiones (Europa del Este, resto de Europa, África, Asia, América Latina y otras). Se establecieron 12 diagnósticos que se compararon entre recién nacidos autóctonos e inmigrantes, y se calculó el riesgo relativo de éstos. Resultados Hubo 1.296 recién nacidos autóctonos (47,8 %) y 1.416 inmigrantes (52,2 %). Las gestantes inmigrantes presentaban mayor incidencia de estado portador de antígeno de superficie de la hepatitis B (HBsAg) (2,0 % frente al 1,0 %) y menor de anticuerpos contra el virus de la hepatitis C (AcVHC) (0,8 % frente al 2,0 %; p < 0,01). Sólo hubo una gestante inmigrante positiva al virus de la inmunodeficiencia humana (VIH), frente a 14 españolas (p < 0,01), y el consumo de drogas era menor en las inmigrantes (0,4 % frente al 4,0 %; p < 0,01). Los recién nacidos inmigrantes tenían menos incidencia de prematuridad (6,0 % frente al 7,6 %) y de bajo peso (2,3 % frente al 4,6 %; p < 0,01). No hubo diferencias significativas de distrés respiratorio ni de acidosis fetal. La incidencia de riesgo de infección neonatal era mayor en los recién nacidos inmigrantes (49,9 % frente al 40,6 %; p < 0,01). Conclusiones Los recién nacidos de madre inmigrante presentan en nuestro medio mejores resultados perinatales que los autóctonos, siendo las complicaciones más frecuentes secundarias a un control prenatal inadecuado

Objectives To describe the characteristics of immigrant women's newborns in our environment, and to compare them with those of native women's newborns. Patients and methods All newborns attended in the Neonatology Section of Hospital del Mar in Barcelona, Spain, in 2003 and 2004 were included (n 5 2,735). Data were prospectively collected in a database. Pregnant immigrant women were classified in 6 regions (Eastern Europe, the rest of Europe, Africa, Asia, Latin America and other countries). Twelve diagnoses were defined and compared between native newborns and those of immigrant parents, and their relative risks were calculated. Results There were 1,296 native newborns (47.8 %) and 1,416 of immigrant origin (52.2 %). Immigrant women showed a higher rate of HBsAg carrier status (2.0 % versus 1.0 %) and a lower rate of hepatitis C virus infection (0.8 % vs 2.0 %; p < 0.01). There was only one HIV-positive pregnant immigrant woman compared with 14 Spanish women (p < 0.01), and drug use was lower in the immigrant group (0.4 % vs 4.0 %; p < 0.01). Immigrant newborns had a lower rate of prematurity (6.0 % vs 7.6 %) and of low birthweight (2.3 % vs 4.6 %; p < 0.01). There were no significant differences in the rate of respiratory distress or fetal acidosis. The incidence of neonatal infection risk was higher in immigrant newborns (49.9 % vs 40.6 %; p < 0.01). Conclusions In our environment, immigrant mothers' newborns have better perinatal outcomes than native newborns. The most frequent complications are secondary to an inadequate

Cuatro casos de eritema fijo medicamentoso en la infancia. Un diagnóstico no siempre fácil / Four cases of fixed drug eruption in children: not always easily diagnosed

El exantema fijo medicamentoso es una de las posibles manifestaciones de las toxicodermias; sin embargo, la presentación pediátrica no es de las más frecuentes. Su característica de localizarse siempre en los mismos sitios puede ayudar a establecer el diagnóstico, pero este dato no favorece el que se establezca de forma precoz. Son múltiples los medicamentos que pueden ocasionarlo. Se presentan 4 casos con sus características clínicas, producidos por 3 fármacos distintos (cotrimoxazol, fenobarbital y paracetamol), así como el diagnóstico diferencial que debe realizarse

Fixed drug eruption is one of the possible clinical presentations of cutaneous reactions to drugs; however, it is not very common in children. Characteristically, it is always localized at the same sites, a fact that can help to establish the diagnosis. but this circumstance is of no help for the early diagnosis. It can be caused by a number of drugs. We describe the clinical features of four cases produced by three different drugs (co-trimoxazole. phenobarbital, paracetamol) and the actions involved in the differential diagnosis

Afectación sistémica en prematuros tras administración intranasal de un colirio de tetrizolina / Systemic involvement in premature infants after intranasal administration of tetryzoline drops

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[Spontaneous passage of a submandibular salivary stone]. / Expulsión espontánea de un cálculo salival submandibular.

Sialolithiasis rarely occurs in children and usually affects the submandibular salivary gland. Because of its rarity, its clinical expression is frequently missed and diagnosis is delayed. We describe the case of a 9-year-old boy with submandibular sialolithiasis who presented spontaneous passage of a large salivary stone. We review the clinical findings and etiopathogenesis of sialolithiasis in children, as well as diagnostic imaging techniques and several therapeutic approaches to stone extraction.

Expulsión espontánea de un cálculo salival submandibular / Spontaneous passage of a submandibular salivary stone

La sialolitiasis es un trastorno poco frecuente en pacientes pediátricos que suele afectar a las glándulas salivales submandibulares. Su rareza hace que a menudo su expresión clínica pase desapercibida y se retrase el diagnóstico. Se presenta el caso de un niño de 9 años con una sialolitiasis submandibular que consigue la salida espontánea de un cálculo de grandes dimensiones mediante manipulación externa. Se revisan los hallazgos clínicos, la etiopatogenia, las técnicas de diagnóstico por la imagen y las diversas técnicas terapéuticas de extracción de cálculos en la sialolitiasis (AU)