Síndrome de pseudotumor cerebri en la población pediátrica: características clínicas, tratamiento y pronóstico / Pseudotumor cerebri in the paediatric population: clinical features, treatment and prognosis

Introducción El síndrome de pseudotumor cerebri (SPTC) en pacientes prepuberales presenta características que lo diferencian respecto a su presentación en la etapa pospuberal. Nuestro objetivo es describir las características de los pacientes diagnosticados de SPTC pediátrico en nuestro centro y compararlas en función de su estado puberal. Pacientes y métodos Se incluyeron a los pacientes diagnosticados de SPTC en un hospital de tercer nivel entre los años 2006 y 2019 con edades comprendidas entre uno y 18 años que cumplieran los criterios diagnósticos actualizados del SPTC. Se clasificaron en función de su estado puberal y peso corporal. Posteriormente, se analizaron los datos de las punciones lumbares, estudios de neuroimagen, valoraciones oftalmológicas, así como el régimen terapéutico recibido a lo largo de su seguimiento. Resultados Se recogieron 28 pacientes, 22 prepuberales y seis pospuberales, con edad media de 9,04 ± 2,86 años. El 83,3% de los pacientes pospuberales eran varones presentando sobrepeso/obesidad en el 66,7%. Eran varones el 27% de los pacientes prepuberales, de ellos asociaban sobrepeso el 31,8%. La sintomatología más frecuente fue cefalea (89,9%) y visión borrosa (42,9%). Todos los pacientes presentaron papiledema; un 21,4% de los casos presentaron parálisis del VI par. Se identificó un posible desencadenante en un 28,6%. El 19% presentaron recurrencia clínica, siendo todos ellos prepuberales. La resolución clínica completa se produjo en el 55,6% de los pacientes. Conclusión Pacientes con SPTC presentan menor prevalencia de obesidad en la etapa prepuberal, junto con un mayor porcentaje de etiologías secundarias y tasa de recurrencia que los pacientes pospuberales. (AU)

Introduction Pseudotumor cerebri (PC) in prepubertal patients displays certain characteristics that differentiate it from its presentation at the postpubertal stage. The aim of this study is to describe the characteristics of paediatric patients diagnosed with PC at our centre and to compare them according to their pubertal status. Patients and methods We included patients aged between 1 and 18 years who were diagnosed with PC in a tertiary-level hospital between 2006 and 2019 and who met the updated diagnostic criteria for PC. They were classified according to body weight and pubertal status. Subsequently, we analysed results from lumbar punctures, neuroimaging studies, ophthalmological assessments, and treatments received during follow-up. Results We included 28 patients, of whom 22 were of prepubertal age and 6 were of postpubertal age. The mean age (standard deviation) was 9.04 (2.86) years. Among the postpubertal patients, 83.3% were boys, 66.7% of whom presented overweight/obesity. In the group of prepubertal patients, 27% were boys, 31.8% of whom were overweight. The most frequent symptoms were headache (89.9%) and blurred vision (42.9%). All patients presented papilloedema, and 21.4% manifested sixth nerve palsy. Possible triggers were identified in 28.6% of cases. Nineteen percent of patients presented clinical recurrence, all of whom were prepubertal patients. Complete clinical resolution was achieved in 55.6% of patients. Conclusion Prepubertal patients with PC show lower prevalence of obesity, higher prevalence of secondary aetiologies, and higher recurrence rates than postpubertal patients. (AU)

Pseudotumor cerebri in the paediatric population: clinical features, treatment and prognosis.

INTRODUCTION: Pseudotumor cerebri (PC) in prepubertal patients displays certain characteristics that differentiate it from its presentation at the postpubertal stage. The aim of this study is to describe the characteristics of paediatric patients diagnosed with PC at our centre and to compare them according to their pubertal status. PATIENTS AND METHODS: We included patients aged between 1 and 18 years who were diagnosed with PC in a tertiary-level hospital between 2006 and 2019 and who met the updated diagnostic criteria for PC. They were classified according to body weight and pubertal status. Subsequently, we analysed results from lumbar punctures, neuroimaging studies, ophthalmological assessments, and treatments received during follow-up. RESULTS: We included 28 patients, of whom 22 were of prepubertal age and 6 were of postpubertal age. The mean age (standard deviation) was 9.04 (2.86) years. Among the postpubertal patients, 83.3% were boys, 66.7% of whom presented overweight/obesity. In the group of prepubertal patients, 27% were boys, 31.8% of whom were overweight. The most frequent symptoms were headache (89.9%) and blurred vision (42.9%). All patients presented papilloedema, and 21.4% manifested sixth nerve palsy. Possible triggers were identified in 28.6% of cases. Nineteen percent of patients presented clinical recurrence, all of whom were prepubertal patients. Complete clinical resolution was achieved in 55.6% of patients. CONCLUSION: Prepubertal patients with PC show lower prevalence of obesity, higher prevalence of secondary aetiologies, and higher recurrence rates than postpubertal patients.

Pseudotumor cerebri in the paediatric population: clinical features, treatment and prognosis. / Síndrome de pseudotumor cerebri en la población pediátrica: características clínicas, tratamiento y pronóstico.

INTRODUCTION: Pseudotumor cerebri (PC) in prepubertal patients displays certain characteristics that differentiate it from its presentation at the postpubertal stage. The aim of this study is to describe the characteristics of paediatric patients diagnosed with PC at our centre and to compare them according to their pubertal status. PATIENTS AND METHODS: We included patients aged between 1 and 18 years who were diagnosed with PC in a tertiary-level hospital between 2006 and 2019 and who met the updated diagnostic criteria for PC. They were classified according to body weight and pubertal status. Subsequently, we analysed results from lumbar punctures, neuroimaging studies, ophthalmological assessments, and treatments received during follow-up. RESULTS: We included 28 patients, of whom 22 were of prepubertal age and 6 were of postpubertal age. The mean age (standard deviation) was 9.04 (2.86) years. Among the postpubertal patients, 83.3% were boys, 66.7% of whom presented overweight/obesity. In the group of prepubertal patients, 27% were boys, 31.8% of whom were overweight. The most frequent symptoms were headache (89.9%) and blurred vision (42.9%). All patients presented papilloedema, and 21.4% manifested sixth nerve palsy. Possible triggers were identified in 28.6% of cases. Nineteen percent of patients presented clinical recurrence, all of whom were prepubertal patients. Complete clinical resolution was achieved in 55.6% of patients. CONCLUSION: Prepubertal patients with PC show lower prevalence of obesity, higher prevalence of secondary aetiologies, and higher recurrence rates than postpubertal patients.

[Multiple cranial neuropathy: a case report of three paediatric patients]. / Neuropatia craneal multiple: descripcion de tres pacientes pediatricos.

TITLE: Neuropatia craneal multiple: descripcion de tres pacientes pediatricos.

Neuropatía craneal múltiple: descripción de tres pacientes pediátricos / Multiple cranial neuropathy: a case report of three paediatric patients

No disponible

[Hereditary primary microcephaly type 5. Not everything is Zika virus]. / Microcefalia primaria hereditaria de tipo 5. No todo es virus del Zika.

TITLE: Microcefalia primaria hereditaria de tipo 5. No todo es virus del Zika.

Complicaciones neurológicas en trasplantados de órgano sólido / Neurological complications in patients receiving solid organ transplants

Introducción: Las complicaciones neurológicas (CN) suponen una parte importante de la morbimortalidad del postoperatorio del trasplante pediátrico de órgano sólido (TPOS).El objetivo fue exponer la experiencia de nuestro hospital, un centro de referencia de trasplante pediátrico cardiaco, hepático y pulmonar. Pacientes y métodos: Estudio descriptivo retrospectivo de 140 pacientes receptores de TPOS en el periodo 2000-2011. Resultados: Presentaron CN 23 pacientes receptores de TPOS (16,4% de casos), con una mediana de edad de 6 años. Las sintomatologías más frecuentes fueron: crisis epilépticas sintomáticas agudas (12 pacientes) y encefalopatía aguda (11 pacientes), seguidas por debilidad neuromuscular (4 niños), temblor (4 niños), cefalea (2 niños), dolor neuropático (2 niños) y alteraciones visuales (2 niños). Las principales etiologías de las CN fueron: neurotoxicidad de los inmunosupresores (12 casos), hipoxia-isquemia cerebral (6 casos), infecciones (2 casos), compresión mecánica de nervio periférico durante la cirugía (2 casos) y trastorno metabólico (un caso). Cinco pacientes presentaron síndrome de encefalopatía posterior reversible (SEPR). Fallecieron 7 pacientes, 4 por encefalopatía hipóxico-isquémica grave. Los pacientes con SEPR evolucionaron favorablemente. Conclusiones: Las CN que se presentan en el postoperatorio del TPOS tienen una incidencia considerable, siendo las crisis epilépticas y la encefalopatía aguda las manifestaciones más comunes. No encontramos diferencia de CN en los diferentes tipos de trasplante. La neurotoxicidad de los inmunosupresores y la hipoxia-isquemia cerebral son las principales causas de CN, teniendo un manejo y evolución diferentes. El pronóstico en la mayoría de casos es favorable, salvo en los afectados por encefalopatía hipóxico-isquémica moderada o grave(AU)

Introduction: Neurological complications (NC) are a significant cause of morbidity and mortality in paediatric patients receiving solid organ transplants. Our aim was to describe the experience of our hospital with NC in paediatric patients receiving heart, lung and liver transplants. Patients and methods: A retrospective study was conducted on 140 paediatric patients who received a solid organ transplant during the period 2000-2011. Results: A total of 23 paediatric solid organ transplant recipients (16.4% of cases), with a median age of 6 years, had NC. The symptoms were, in order of frequency: acute symptomatic seizures (12 patients); acute encephalopathy (11 patients); neuromuscular weakness (4 children), tremor (4 children), headache (2 children), neuropathic pain (2 children), and visual disturbances (2 children). The aetiologies of NC were: the neurotoxicity of the immunosuppressive drugs (12 patients), post-hypoxic-ischaemic encephalopathy (6 patients), infections (2 cases), mechanical compression of peripheral nerve during surgery (2 cases), and a metabolic complication (1 case). The five patients who met the criteria of posterior reversible encephalopathy syndrome had a favourable outcome. Seven patients died, four of them due to hypoxic-ischaemic encephalopathy. Conclusions: NC are common in paediatric patients receiving heart, liver, lung, and renal transplants, with acute symptomatic seizures and acute encephalopathy being the most common clinical signs. No differences were found in the NC with the different types of transplants. Neurotoxicity of the immunosuppressive drugs and hypoxic-ischaemic encephalopathy were the main causes of NC, having different management and outcomes. The prognosis was favourable in most of the patients, except for those who had moderate or severe post-hypoxic-ischaemic damage(AU)

[Neurological complications in patients receiving solid organ transplants]. / Complicaciones neurológicas en trasplantados de órgano sólido.

INTRODUCTION: Neurological complications (NC) are a significant cause of morbidity and mortality in paediatric patients receiving solid organ transplants. Our aim was to describe the experience of our hospital with NC in paediatric patients receiving heart, lung and liver transplants. PATIENTS AND METHODS: A retrospective study was conducted on 140 paediatric patients who received a solid organ transplant during the period 2000-2011. RESULTS: A total of 23 paediatric solid organ transplant recipients (16.4% of cases), with a median age of 6 years, had NC. The symptoms were, in order of frequency: acute symptomatic seizures (12 patients); acute encephalopathy (11 patients); neuromuscular weakness (4 children), tremor (4 children), headache (2 children), neuropathic pain (2 children), and visual disturbances (2 children). The aetiologies of NC were: the neurotoxicity of the immunosuppressive drugs (12 patients), post-hypoxic-ischaemic encephalopathy (6 patients), infections (2 cases), mechanical compression of peripheral nerve during surgery (2 cases), and a metabolic complication (1 case). The five patients who met the criteria of posterior reversible encephalopathy syndrome had a favourable outcome. Seven patients died, four of them due to hypoxic-ischaemic encephalopathy. CONCLUSIONS: NC are common in paediatric patients receiving heart, liver, lung, and renal transplants, with acute symptomatic seizures and acute encephalopathy being the most common clinical signs. No differences were found in the NC with the different types of transplants. Neurotoxicity of the immunosuppressive drugs and hypoxic-ischaemic encephalopathy were the main causes of NC, having different management and outcomes. The prognosis was favourable in most of the patients, except for those who had moderate or severe post-hypoxic-ischaemic damage.

Síndrome DAMP: otra perspectiva del niño TDAH / DAMP syndrome: another approach to the ADHD child

La definición que el DSM-IV-TR hace del Trastorno por Déficit de Atención e Hiperactividad (TDAH) no hace ninguna referencia a la evidencia de muchos trabajos europeos que demuestran una mayor frecuencia de trastornos motores o alteraciones en el desarrollo de la coordinación en niños con trastornos hipercinéticos. En 1989, la Academia Americana de Psiquiatría incluye la categoría diagnóstica de Trastorno del Desarrollo de la Coordinación (TDC) para definir a niños con dificultades en el desarrollo de habilidades motoras. Existe un fenotipo clínico con entidad propia caracterizado por reunir criterios de TDAH y de TDC, en ausencia de retraso mental y parálisis cerebral, descrito por autores escandinavos en la década de los 70, conocido por el acrónimo DAMP (Déficit de Atención, control Motor y de la Percepción), que se presenta hasta en un 50% de los pacientes con ambos diagnósticos. La evolución natural del niño con DAMP es menos favorable que en el TDAH puro, con mayor riesgo de fracaso escolar e incluso de ser víctimas de acoso escolar. Los neuropediatras y pediatras, pero también los psiquiatras infantiles, deben reconocer y evaluar las dificultades motoras y de coordinación de estos pacientes y realizar recomendaciones apropiadas. Nuestro objetivo es destacar la importancia de los trastornos motores en el niño afecto de TDAH y contribuir a la difusión de esta entidad que va a precisar un abordaje diagnóstico y terapéutico diferenciado

The definition for ADHD within the DSM-IV-TR doesn't refer to the evidence of any European papers which show a higher frequency of motor impairment or alterations in the development of coordination in children with hyperkinetic disorders. In 1989, the American Academy of Psychiatry includes the diagnostic category of Developmental Disorder Coordination (DCD) to diagnose children with difficulties in the development of motor skills. There is a clinical phenotype characterized as a separated entity with criteria for ADHD and DCD, in the absence of mental retardation and cerebral palsy, described by scandinavian authors in the 70's and known by the acronym DAMP (Deficit in Attention, Motor control and Perception), which occurs in up to 50% of patients with both diagnoses. The natural history of children with DAMP is less favorable than pure ADHD, with greater risk of school failure and even of bullying. The neurologists, pediatricians and pediatric psychiatrists must recognize and evaluate motor and coordination difficulties of these patients and make appropriate recomendations. Our aim is to note the importance of motor disorders in children with ADHD and contribute to spread differential diagnosis and therapeutic approaches

Encefalopatía aguda necrosante familiar o recurrente desencadenada por infecciones / Infection-triggered familial or recurrent acute necrotizing encephalopathy

La encefalopatía aguda necrosante (EAN) es una encefalopatía rápidamente progresiva que se presenta en niños por lo demás normales asociada a infecciones víricas comunes, como influenza y parainfluenza. La mayoría de los casos son esporádicos y no recurrentes, y se han descrito en pacientes asiáticos, aunque también se han comunicado casos aislados en países occidentales. Recientemente se han encontrado mutaciones en heterocigosis de un gen que codifica una proteína componente del poro nuclear, denominada Ran Binding Protein 2 (RANBP2), en un número significativo de pacientes con esta forma familiar o recurrente de EAN.A continuación se describe una familia española con la forma familiar y recurrente de EAN, en la que el estudio de secuenciación del gen RANBP2 fue negativo. Las mutaciones del gen RANBP2 no son el único alelo que determina susceptibilidad para el desarrollo de la forma familiar o recurrente de EAN (AU)

Acute necrotizing encephalopathy (ANE) presents in children after common viral infections. Most cases of ANE are non-familial and non-recurrent and have been mainly reported in Asian patients, although ANE affects children worldwide. Recently, missense mutations in the gene encoding the nuclear pore protein Ran Binding Protein 2 (RANBP2) have been found in several families with familial or recurrent cases of ANE. We describe a Spanish family with familial and recurrent ANE without mutations in RANBP2. Mutations in RANBP2 are not the sole susceptibility alleles for familial or recurrent ANE (AU)

[Infection-triggered familial or recurrent acute necrotizing encephalopathy]. / Encefalopatía aguda necrosante familiar o recurrente desencadenada por infecciones.

Acute necrotizing encephalopathy (ANE) presents in children after common viral infections. Most cases of ANE are non-familial and non-recurrent and have been mainly reported in Asian patients, although ANE affects children worldwide. Recently, missense mutations in the gene encoding the nuclear pore protein Ran Binding Protein 2 (RANBP2) have been found in several families with familial or recurrent cases of ANE. We describe a Spanish family with familial and recurrent ANE without mutations in RANBP2. Mutations in RANBP2 are not the sole susceptibility alleles for familial or recurrent ANE.

Revisión de los parámetros hematológicos y bioquímicos para identificar la ferropenia / Review of haematology and biochemistry parameters to identify iron deficiency

Introducción: La ferropenia es una de las deficiencias nutricionales más frecuentes en la primera infancia. En las últimas décadas se han incorporado nuevas técnicas para el diagnóstico de la ferropenia a los clásicos marcadores bioquímicos; sin embargo, no se conoce bien qué parámetros deberían incluirse en un panel para identificar el déficit de hierro y la anemia ferropénica. Los objetivos de este estudio fueron los siguientes: a) determinar los valores de los parámetros hematológicos eritrocíticos y del contenido de hemoglobina eritrocitaria (CHr), así como de ferritina, de sideremia, de saturación de transferrina, de transferrina y de capacidad total de fijación de hierro, con objeto de analizar su relevancia en la identificación de la ferropenia en la muestra, y b) determinar qué parámetros hematológicos y bioquímicos son predictores independientes de ferropenia en la muestra estudiada. Pacientes y métodos: La muestra procedía de una población urbana con una edad comprendida entre los 6 meses y los 14 años, de ambos sexos. El protocolo de estudio incluía un cuestionario y la realización de una analítica que constaba de hemograma con CHr y bioquímica del metabolismo férrico. Resultados: Se incluyó a 237 niños. El análisis de regresión logística identificó al CHr y al hierro como los únicos parámetros independientemente asociados al diagnóstico de ferropenia (p<0,05); la reducción relativa del riesgo fue más significativa para el parámetro CHr. Conclusiones: Este estudio apoya que un panel basado exclusivamente en parámetros hematológicos, con la inclusión del CHr, es una alternativa válida al panel conjunto hematológico y bioquímico tradicionalmente empleado para identificar el déficit de hierro y la anemia ferropénica en la infancia (AU)

Introduction: There has been a continuous improvement in the methods to detect iron deficiency, a common condition in children, in the last decades or so, but it is still difficult to establish which parameters should be included in a diagnostic panel for iron deficiency and iron deficiency anaemia. The objectives of this study were to evaluate the diagnostic efficiency of commonly used haematological and biochemical markers, as well as the reticulocyte haemoglobin content (CHr) in the diagnosis of iron deficiency with or without anaemia. Study design: A descriptive cross-sectional study was carried out on an urban population of both sexes aged 6 months to 14 years. A complete blood cell count with CHr was obtained. Biochemical markers of iron metabolism, transferrin saturation, serum iron, ferritin and total iron binding capacity were also measured. Results: Samples were obtained for 237 children. A multiple stepwise logistic regression analysis identified CHr and iron serum as the only parameters independently associated to iron deficiency (P<0.05). CHr was the strongest predictor of iron deficiency and iron deficiency anaemia. Conclusions: Our study indicates that the measurement of CHr may be a reliable method to assess deficiencies in tissue iron supply. CHr together with a complete blood count may provide an alternative to the traditional biochemical panel for the diagnosis of iron deficiency in children (AU)

Contenido de hemoglobina reticulocitaria para el diagnóstico de la ferropenia / Reticulocyte haemoglobin content in the diagnosis of iron deficiency

Introducción: El reconocimiento del déficit de hierro es crucial para administrar un tratamiento precoz que prevenga las complicaciones multisistémicas de la anemia ferropénica. El parámetro contenido de hemoglobina reticulocitaria (CHr) ha demostrado mayor efectividad que los índices convencionales para detectar el déficit de hierro antes de su progresión a anemia en determinadas poblaciones. Los objetivos de este estudio fueron valorar la utilidad del CHr para el diagnóstico del déficit de hierro y de la anemia ferropénica en España y determinar el valor del CHr con mejor rendimiento para el diagnóstico de ferropenia. Pacientes y métodos: La muestra procedía de una población urbana de ambos sexos con una edad comprendida entre los 6 meses y los 14 años. El protocolo de estudio incluía un cuestionario y la realización de una analítica que constaba de hemograma con CHr y bioquímica del metabolismo férrico. Resultados: Se incluyeron 237 niños. La cifra del CHr correspondiente a 25pg mostró la mejor combinación de sensibilidad (90,7%) y especificidad (80,1%). En los grupos con déficit de hierro y con anemia ferropénica la media del CHr se situó por debajo de 25pg, mientras que en aquéllos con anemia no ferropénica y normal la media fue igual o superior a este valor. Conclusiones: El CHr es un parámetro hematológico útil para diagnosticar la ferropenia en la población infantil. La cifra de 25pg demostró ser el punto de corte más adecuado para identificar el déficit de hierro acompañado o no de anemia por su elevado rendimiento diagnóstico (AU)

Introduction: The detection of iron deficiency is essential in order to start early treatment to prevent long-term systemic complications of iron deficiency anaemia. Reticulocyte haemoglobin content (CHr) has been shown to be a helpful indicator for detecting iron deficiency before the development of anaemia. The objectives of this study were to evaluate the efficiency of CHr in the assessment of iron deficiency with or without anaemia and to determine the cut-off value with the best diagnostic yield. Study design: A descriptive cross-sectional study was carried out on an urban population of both sexes aged 6 months to 14 years. The study protocol included a questionnaire and taking a venous blood sample for a complete blood cell count with CHr and biochemical indicators of iron status. Results: Samples were obtained for 237 children. A CHr cut-off value of 25pg had an overall sensitivity of 90.7% and specificity of 80.1% for the diagnosis of iron deficiency with or without anaemia. The value of CHr was below 25pg in the diagnostic groups with iron deficiency and iron deficiency anaemia, and above this value in the diagnostic groups with non-iron deficient anaemia or normal. Conclusions: CHr is a useful hematological marker to identify iron deficiency and iron deficiency anaemia in childhood. A CHr value of 25pg showed the best performance to identify iron deficiency with or without anaemia (AU)

[Reticulocyte haemoglobin content in the diagnosis of iron deficiency]. / Contenido de hemoglobina reticulocitaria para el diagnóstico de la ferropenia.

INTRODUCTION: The detection of iron deficiency is essential in order to start early treatment to prevent long-term systemic complications of iron deficiency anaemia. Reticulocyte haemoglobin content (CHr) has been shown to be a helpful indicator for detecting iron deficiency before the development of anaemia. The objectives of this study were to evaluate the efficiency of CHr in the assessment of iron deficiency with or without anaemia and to determine the cut-off value with the best diagnostic yield. STUDY DESIGN: A descriptive cross-sectional study was carried out on an urban population of both sexes aged 6 months to 14 years. The study protocol included a questionnaire and taking a venous blood sample for a complete blood cell count with CHr and biochemical indicators of iron status. RESULTS: Samples were obtained for 237 children. A CHr cut-off value of 25 pg had an overall sensitivity of 90.7% and specificity of 80.1% for the diagnosis of iron deficiency with or without anaemia. The value of CHr was below 25 pg in the diagnostic groups with iron deficiency and iron deficiency anaemia, and above this value in the diagnostic groups with non-iron deficient anaemia or normal. CONCLUSIONS: CHr is a useful hematological marker to identify iron deficiency and iron deficiency anaemia in childhood. A CHr value of 25 pg showed the best performance to identify iron deficiency with or without anaemia.

[Review of haematology and biochemistry parameters to identify iron deficiency]. / Revisión de los parámetros hematológicos y bioquímicos para identificar la ferropenia.

INTRODUCTION: There has been a continuous improvement in the methods to detect iron deficiency, a common condition in children, in the last decades or so, but it is still difficult to establish which parameters should be included in a diagnostic panel for iron deficiency and iron deficiency anaemia. The objectives of this study were to evaluate the diagnostic efficiency of commonly used haematological and biochemical markers, as well as the reticulocyte haemoglobin content (CHr) in the diagnosis of iron deficiency with or without anaemia. STUDY DESIGN: A descriptive cross-sectional study was carried out on an urban population of both sexes aged 6 months to 14 years. A complete blood cell count with CHr was obtained. Biochemical markers of iron metabolism, transferrin saturation, serum iron, ferritin and total iron binding capacity were also measured. RESULTS: Samples were obtained for 237 children. A multiple stepwise logistic regression analysis identified CHr and iron serum as the only parameters independently associated to iron deficiency (P<0.05). CHr was the strongest predictor of iron deficiency and iron deficiency anaemia. CONCLUSIONS: Our study indicates that the measurement of CHr may be a reliable method to assess deficiencies in tissue iron supply. CHr together with a complete blood count may provide an alternative to the traditional biochemical panel for the diagnosis of iron deficiency in children.

[Infant botulism]. / Botulismo del lactante.

We report a case of botulism in a 40 day old infant. The patient presented a descending flaccid paralysis requiring mechanical ventilation for 12 days. She is the first European patient treated with Human Botulism Immune Globulin. A few weeks later a second case of infant botulism was detected in our geographical region in Southern Spain. We emphasise the importance of an early diagnosis and treatment with Human Botulism Immune Globulin to decrease morbidity.

Botulismo del lactante / Infant botulism

Comunicamos la detección de botulismo en un lactante de 40 días que presentó parálisis flácida descendente con insuficiencia respiratoria grave que requirió ventilación mecánica durante 12 días. Se le administró inmunoglobulina humana específica (IHE) para el botulismo del lactante, y es el primer caso europeo que recibe esta medicación. Unas semanas más tarde se ha detectado un segundo caso en nuestra comunidad autónoma. Destacamos la importancia del diagnóstico e indicación precoz del tratamiento con IHE, lo que disminuye la morbilidad (AU)

We report a case of botulism in a 40 day old infant. The patient presented a descending flaccid paralysis requiring mechanical ventilation for 12 days. She is the first European patient treated with Human Botulism Immune Globulin. A few weeks later a second case of infant botulism was detected in our geographical region in Southern Spain. We emphasise the importance of an early diagnosis and treatment with Human Botulism Immune Globulin to decrease morbidity (AU)