Lesiones en las uñas de pies y manos / Lesions in fingernails and toenails

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Tuberculoma cerebral en un niño / Cerebral Tuberculoma in one child

Presentamos el caso de un niño con un tuberculoma cerebral, el primer caso diagnosticado en nuestro hospital. Un diagnóstico, infrecuente en nuestro medio, que debemos tener en mente. La ausencia de una clínica e imágenes específicas hacen difícil establecer el diagnóstico, especialmente en ausencia de lesiones extracraneales y de datos histológicos (AU)

The case of a child with a cerebral tuberculoma, the first one diagnosed in our hospital, is presented. This diagnosis, infrequent in our environment, should be kept in mind. The absence of specific symptoms and images makes the diagnosis difficult, especially without extracranial lesions and histological data (AU)

Niña de 10 años con infección por el nuevo virus de influenza A (H1N1) / A 10-year- old female child infected by the new influenza virus A (H1N1)

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[Normal physiological variations of pubertal development: starting age of puberty, menarcheal age and size]. / Variaciones fisiológicas normales del desarrollo puberal: edad del inicio puberal, edad de la menarquia y talla.

OBJECTIVES: To evaluate the impact of early, mid-onset, and late maturation, assessed by the age at menarche, height at the beginning of puberty, time of menarche, at one and two years after menarche in a group of healthy girls. The time lapse between the start of puberty and the advent of menarche was observed in that group of girls. To investigate whether their weight status (body mass index) is causally implicated in early start of puberty in these girls. PATIENTS AND METHODS: A prospective observational study was performed on 266 healthy Caucasian girls, who were followed up with visits at the beginning of puberty, at menarche and then every six months. Physical examinations included height, weight and pubertal stages, and were assessed by clinical examination according to methods of Tanner. The statistical analysis was performed using the SPSS 12.0 package. RESULTS: We found that mean age of breast development 2 (B2) was 10.72 years and mean menarcheal age was 12.43 years. The correlation coefficient (r) between the onset of puberty and its duration was r = -0.406 (p < 0.01), and that of age of pubertal onset versus age of menarche was r = 0.34 (p < 0.01). According to 25th and 80th percentiles, early matures were shorter at onset of puberty, at menarche and two years later. Post-menarcheal increase in stature was greatest in early maturers. There is also a correlation between the "z" score of body mass index and the age at onset of puberty (r = -0.398). CONCLUSIONS: The puberty began at 10.72 years, the menarche appears at 12.43 as average. Girls who matured early were shorter at onset, at menarche and two years after, despite having greater peak height velocity and post-menarcheal increase in height. The age of menarche correlated with the "z" score of body mass index.

Variaciones fisiológicas normales del desarrollo puberal: edad del inicio puberal, edad de la menarquia y talla / Normal physiological variations of pubertal development: starting age of puberty, menarcheal age and size

Objetivos: Evaluar el impacto F de una maduración adelantada, promedio y tardía, de acuerdo con la edad de la menarquia, en la talla al comienzo de la pubertad, en el momento de la menarquia, 1 y 2 años después de la menarquia en un grupo de niñas sanas. Observar la duración de la pubertad, el tiempo transcurrido desde su inicio y la aparición de la menarquia en dicho grupo de niñas. Investigar si el índice de masa corporal guarda alguna relación con el inicio puberal y la menarquia. Pacientes y métodos: Se ha realizado un estudio observacional prospectivo en 266 niñas sanas. Todas las niñas son de raza blanca, fueron exploradas en visitas programadas antes del inicio puberal, al comienzo del desarrollo puberal (estadio B2 del desarrollo mamario), en el mes que tuvieron la menarquia y después cada 6 meses. Resultados: Encontramos una edad media de desarrollo mamario (B2) de 10,72 años y una edad media de la menarquia de 12,43 años. Existe una correlación significativa negativa (r: -0,406) entre el inicio puberal (B2) y su duración, y una correlación positiva (r: 0,34) entre las edades del inicio puberal y de la menarquia. De acuerdo con los percentiles 25 y 80, las maduradoras adelantadas eran más bajas al inicio puberal, en la menarquia y 2 años más después de ésta. El incremento en la estatura tras la menarquia fue mayor en las maduradoras adelantadas. Hay una correlación negativa entre la puntuación "z" del índice de masa corporal y el inicio de la pubertad (r: -0,398). Conclusiones: La pubertad se inició a una edad media de 10,72 años, y la menarquia, a los 12,43 años. Las niñas maduradoras adelantadas presentaron una talla inferior al inicio puberal, en la menarquia y 2 años después de la menarquia en relación con las otras niñas en estos mismos acontecimientos puberales, y tuvieron un mayor incremento de la talla tras la menarquia que las otras niñas. La edad de la menarquia se correlaciona con la puntuación "z" del índice de masa corporal

Objectives: To evaluate the impact of early, mid-onset, and late maturation, assessed by the age at menarche, height at the beginning of puberty, time of menarche, at one and two years after menarche in a group of healthy girls. The time lapse between the start of puberty and the advent of menarche was observed in that group of girls. To investigate whether their weight status (body mass index) is causally implicated in early start of puberty in these girls. Patients and methods: A prospective observational study was performed on 266 healthy Caucasian girls, who were followed up with visits at the beginning of puberty, at menarche and then every six months. Physical examinations included height, weight and pubertal stages, and were assessed by clinical examination according to methods of Tanner. The statistical analysis was performed using the SPSS 12.0 package. Results: We found that mean age of breast development 2 (B2) was 10.72 years and mean menarcheal age was 12.43 years. The correlation coefficient (r) between the onset of puberty and its duration was r -0.406 (p < 0.01), and that of age of pubertal onset versus age of menarche was r 0.34 (p < 0.01). According to 25th and 80th percentiles, early matures were shorter at onset of puberty, at menarche and two years later. Post-menarcheal increase in stature was greatest in early maturers. There is also a correlation between the "z" score of body mass index and the age at onset of puberty (r -0.398). Conclusions: The puberty began at 10.72 years, the menarche appears at 12.43 as average. Girls who matured early were shorter at onset, at menarche and two years after, despite having greater peak height velocity and post-menarcheal increase in height. The age of menarche correlated with the "z" score of body mass index

Razones que han motivado la campaña de vacunación 2003-2004 contra la meningitis C en Castilla-La Mancha / Reasons for the 2003-2004 meningitis C vaccination campaign in Castilla-La Mancha

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[Bone mineral density and bone mineral content variations in various communities]. / Variaciones de la densidad y de la concentración mineral ósea entre distintas comunidades.

OBJECTIVE: To study the bone mineral density (DMO) and the bone mineral concentration (CMO) in lumbar spine (L2 and L4) by dual-energy x-ray absorptiometry with a lunar DPX (DEXA) in a children sample of the community of Madrid; to relate the values obtained with the age, sex and pubertal development; and to compare the values of DMO found with the publications of other autonomous communities. MATERIALS AND METHODS: 351 children, 184 boys and 167 girls selected at random in our environment. The age range oscillated between 6 months and 20 years. Grouped in intervals of a year according to the sex; and in accordance with the pubertal development. The bone mineral content was measured by dual-energy x-ray absorptiometry with a lunar DPX in the lumbar spine at level of L2-L4. The statistic analysis has been accomplished with the SPSS version 6.0.1. They have been obtained the average and deviation standard for each group from studied age, and also according to pubertal development; the DMO and CMO of the boys and girls have been compared by groups of age; the DMO and CMO within each sex between a group of age and the immediately superior have been compared through an analysis of the variance; the effect that the age has on the DMO and the CMO has been evaluated and finally through multivariant analysis techniques the regression models have been estimated between the age and the DMO, and the age with the CMO. CONCLUSION: The DMO shows variations between the various communities and even in different samples of a same community, in Carrascosa study the DMO is highest, expressed in SD score, in many several groups of age studied with respect to our values and with the values of Moreno et al and Armadá et al; the values of DMO in our study are greater than the ones found by Moreno et al and Armadá et al; the first four years and the adolescence are the periods of maximum increase of the DMO, but it also increases in an oscillatory way in the intermediate stages; the girls present some highest levels of DMO in the groups of age of 12-13 and 14-15 years, probably in relationship to a most precocious beginning of the puberty; and finally the regression line of the DMO as compared to the age for both sexes are parallel and have equal court point, what means that they are coincident.

Variaciones de la densidad y de la concentración mineral ósea entre distintas comunidades / Bone mineral density and bone mineral content variations between different communities

OBJETIVO: a) Estudiar la densidad mineral ósea (DMO) y la concentración mineral ósea (CMO) en columna lumbar (L2 y L4) con densitometría radiológica de doble energía (DEXA) en una muestra de niños de la comunidad de Madrid, b) relacionar los valores obtenidos con la edad, sexo y desarrollo puberal, y c) comparar los valores de DMO encontrados con los publicados de otras comunidades autónomas. MATERIAL Y MÉTODOS: Fueron seleccionados al azar en nuestra consulta 351 escolares: 184 niños y 167 niñas. El rango de edad osciló entre 6 meses y 20 años. Los sujetos fueron agrupados en intervalos de un año según el sexo; y de acuerdo al desarrollo puberal.El contenido mineral óseo fue medido con densitometría radiológica de doble energía en la columna lumbar en L2-L4 con un modelo lunar DPX-L. El análisis estadístico se ha realizado con el SPSS versión 6.0.1. Se han obtenido la media y desviación estándar para cada grupo de edad estudiado, y también según los estadios de Tanner; se han comparados las DMO y CMO del sexo masculino y femenino por grupos de edad; se han comparado las DMO y CMO dentro de cada sexo entre un grupo de edad y el inmediatamente superior mediante análisis de la variancia; se ha evaluado el efecto que tiene la edad sobre la DMO y la CMO y, por último, mediante técnicas de análisis multivariante se han estimado los modelos de regresión entre la edad y la DMO, y la edad con la CMO. RESULTADOS: La DMO presenta variaciones entre las diversas comunidades y aun en muestras diferentes de una misma comunidad. En el estudio de Carrascosa et al la DMO, expresada en DE score, es más alta en numerosos de los grupos de edad estudiados respecto a nuestros valores y a los de Moreno et al y Armadá et al; los valores de DMO en nuestro estudio son mayores que los encontrados por Moreno et al y Armadá et al en casi todos los grupos de edad; al contrastar la DMO según los estadios de Tanner nuestros valores fueron, en general, superiores a los de los otros estudios en todos los estadios; los primeros 4 años y la adolescencia son los períodos de máximo incremento de la DMO, pero también aumenta de forma oscilante en las etapas intermedias; las niñas presentan unos valores más altos de DMO en los grupos de edad de 12-13 y 14-15 años, probablemente en relación con un inicio más precoz de la pubertad y, por último, las rectas de regresión de la DMO frente a la edad para ambos sexos son paralelas y tienen igual punto de corte, lo que significa que son coincidentes. Igual sucede para la CMO (AU)

[Growth and the assessment of body composition in children treated with the growth hormone]. / Crecimiento y valoración de la composición corporal en niños tratados con hormona de crecimiento.

OBJECTIVE: The objective of the present work was to analyze the variations in corporal composition of children treated with growth hormone. PATIENTS AND METHODS: Nineteen patients, 8 girls and 11 boys, with growth retardation were studied. The mean age of these children was 8.6 years with a range of 4 to 13 years. Growth hormone (GH) secretion was evaluated by using clonidine and insulin stimulation to evaluate the presence of classic and partial deficits of GH. The integrated 24-hour GH concentration was evaluated in the children with neurosecretory dysfunction of GH and with biologically inactive GH. IGF-I and IGFBP3 levels were also studied. Bio-electric impedance was measured with a corporal composition analyzer (Maltron BF 905). The software used, taking into account the weight and height of the children and employing Lukaski's equation, give the following information: impedance in Ohms, Lean mass and fat mass in percentage and Kg, corporal water in liters and percentage, basal metabolism, ideal water and ideal fat. The auxological data were obtained with precision instruments. Analysis of variance (ANOVA) was used to determine if differences existed between the parameters studied at baseline and at 3, 6, 9 and 12 months of treatment. The correlation between the resistance index and total corporal water was calculated, as well as between tricipital skinfold thickness and corporal fat. RESULTS: The patients experienced an increase in lean mass (not significant = NS), an increase in corporal water (p < 0.01), a decrease in the percentage of fat (NS), a decrease in tricipital and subscapular skinfolds (p < 0.05 and NS, respectively), an increase in the perimeter of the arm muscle (NS), an increase in basic metabolism (NS) and a decrease in electrical impedance (NS). The resistance index had a linear relationship with total body water (r = 0.9) and tricipital skinfold with corporal fat (r = 0.8).