Emotional impact on children during home confinement in Spain.

Introduction: The COVID-19 pandemic has brought about important changes. On March 14, 2020, a strict home confinement was decreed in Spain. Children did not attend school and were not allowed to leave their homes. The aim of this study was to determine the emotional state of these children, as well as associated factors. Material and methods: A cross-sectional descriptive study was conducted using an online questionnaire sent by cell phone. This survey includes sociodemographic items and questions concerning the emotional impact of the lockdown. With the questions on emotions, two categories of emotional state were established with the variables fear, irritability, sadness and somatization: those who were less or more emotionally affected. A multivariate logistic model was used to estimate the associations between the variables. Results: A total of 3,890 responses were obtained. The mean age of the children was 6.78 years (range 0 to 16). A score indicating poor emotional state was reported by 40.12%. The multivariate logistic model for poor emotional state was directly associated with having less appetite, sleep disturbances, and with parents' beliefs that their child will have difficulties returning to normal life after lockdown. A better emotional state was associated with being an only child, access to outdoor spaces at home, having pets, and parents informing their children about the pandemic using creative explanations. Conclusions: During strict home confinement, a considerable emotional impact was observed in children as described by their parents. Specific elements were associated with a better or poorer emotional state.

Cuidados y atención hospitalaria en un niño con osteogénesis imperfecta

RESUMEN Introducción: La osteogénesis imperfecta es un trastorno hereditario del tejido conectivo que condiciona fragilidad ósea y susceptibilidad a fracturas. Es una enfermedad sistémica con posibilidad de afectación esquelética y extraesquelética. Su cuidado es, por tanto, multidisciplinar y el papel de los profesionales de la pediatría es primordial. Objetivo: Aportar información sobre las características y el cuidado de la osteogénesis imperfecta, a través de la descripción de un caso clínico. Pesentación del caso: Niño de 2 años y 3 meses de edad, de origen argelino y de padres consanguíneos. Fue diagnosticado en su país de origen de una forma recesiva de osteogénesis imperfecta en los primeros meses de vida por fracturas a repetición. Conclusiones: La manipulación cuidadosa, el control del dolor y el apoyo emocional, entre otros, son fundamentales. Los profesionales de pediatría, como agentes activos en estos casos, deben conocer las peculiaridades del cuidado de pacientes con osteogénesis imperfecta para evitar y detectar complicaciones asociadas. En las familias el conocimiento conlleva además, una toma de conciencia sanitaria acerca de esta enfermedad.

ABSTRACT Introduction: Osteogenesis imperfecta is an hereditary disorder of the connective tissue that conditions to bone fragility and sensitivity to fractures. It is a systemic disease with a possibility of skeletic and extraskeletic affectations. Therefore, its care is multidisciplinary and the role of Pediatrics professionals is paramount. Objective: Contribute with information on the characteristics and the care of osteogenesis imperfecta through the description of a clinical case. Case presentation: Boy of 2 years and 3 months old, from Algeria and with parents by blood. He was diagnosed in his country with a recesive osteogenesis imperfecta in the first months of life due to repeated fractures. Conclusions: Careful handling, pain control and emotional support, among others, are important. Pediatric professionals as active agents in these cases should know the peculiarities of the care of patients with osteogenesis imperfecta to avoid and detect asssociated complications. In the families, knowledge on this also entails sanitary awareness on the disease.

Degree of Accuracy of the BMI Z-Score to Determine Excess Fat Mass Using DXA in Children and Adolescents.

Obesity is caused by fat accumulation. BMI Z-score is used to classify the different degrees of weight status in children and adolescents. However, this parameter does not always express the true percentage of body fat. Our objective was to determine the degree of agreement between the fat mass percentage measured by DXA and the stratification of weight according to BMI Z-score in the pediatric age group. We designed a descriptive cross-sectional study. The patients were classified as underweight/normal weight with Z-scores between -2 and +0.99, overweight from 1 to 1.99, obese from 2 to 2.99, and very obese ≥3. We included 551 patients (47% girls), with a mean age of 11.5 ± 2.8 years (3.7-18 years). Higher BMI Z-scores were associated with a higher percentage of total fat (p < 0.001). However, there were important overlaps between both parameters, such that the BMI Z-score classified patients with the same percentage of total fat mass as having a different nutritional status classification. In conclusion, the stratification of weight status according to BMI Z-score revealed that 46.7% of patients had a fat percentage that did not correspond to their classification. For a more accurate weight assessment in clinical practice, we recommend combining anthropometric indices with diagnostic tools that better correlate with DXA, such as electrical bioimpedance.

Hiperinsulinismo congénito en tres pacientes de la misma familia. Ampliando el genotipo de esta enfermedad / Congenital hyperinsulinism in three patients from the same family. Expanding the genotype of this disease

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Insulin Resistance as a Diagnostic Criterion for Metabolically Healthy Obesity in Children.

OBJECTIVES: In recent years, a subgroup of individuals with obesity has been described as having a lower risk of metabolic and cardiovascular complications. These individuals have what is referred to as metabolically healthy obesity (MHO), which has a favorable metabolic profile and a lower probability of long-term complications. The definition of this subtype in children is not clear. The aim of the present study was to determine whether Homeostasis Model Assessment (HOMA) above a set threshold could be the marker of metabolically unhealthy obesity (MUO) in children, or a parameter that can be used in the overall assessment. It is intended to compare the International Diabetes Federation (IDF) criteria against HOMA in the diagnosis of MUO. METHODS: This observational, retrospective, cohort study included children with obesity and analyzed their metabolic state by means of blood testing and dual-energy X-ray absorptiometry. RESULTS: A total of 96 patients were included, 44.8% boys and 55.2% girls, ages 6-17 years. The patients with MHO according to the HOMA criterion were younger (P = 0.001), had a lower body mass index (BMI) z score (P = 0.006), waist-height index (P = 0.009), hip-height index (P = 0.010), blood glucose (P = 0.003), insulin (P < 0.001), and lower percentages of total fat (P = 0.002), trunk fat (P = 0.001), and android fat (P = 0.009) than those with MUO. The logistic regression analysis according to IDF criteria detected an area under the receiver operating characteristic (ROC) curve of 0.659 (95% CI 0.546-0.771; P = 0.009) versus the area under the ROC curve of 0.854 (95% CI 0.777-0.931; P < 0.001) for the HOMA definition. Therefore, the determination of the metabolic state according to HOMA has greater sensitivity and specificity than the IDF criteria. The multivariate analysis in children classified according to HOMA revealed that the percentage of total fat and gynoid fat distributions and triglyceride level could be markers of a healthy or unhealthy metabolic state in children with obesity (P < 0.001). CONCLUSIONS: The use of HOMA as a single criterion was demonstrated to be an effective and simple detector of adiposity, which predicts the metabolically healthy obesity in children.

Absceso tiroideo de origen polimicrobiano en un niño / Thyroid abscess of polymicrobial origin in a child

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Endocrinological anomalies in a patient with 12q14 microdeletion syndrome. Completing phenotype of this exceptional short stature condition.

12q14 microdeletion syndrome consists of the association of short stature, mental retardation, and osteopoikilosis. Since its first description in 2007, there have been <20 cases reported and each case presented variable phenotypes. We present a girl with 12q14 microdeletion that showed mental retardation and short stature but without osteopoikilosis. She also exhibited precocious puberty and growth hormone deficiency and required treatment for improving final height. This report adds further to the knowledge of the endocrinological anomalies in 12q14 microdeletion syndrome. It is important to perform growth hormone level measurements and pubertal signs to follow-up with these patients and avoid the consequential adult height worsening.

Niveles plasmáticos de antirretrovirales en niños con infección por el virus de la inmunodeficiencia humana. Influencia del género y de la edad / Plasma antiretroviral levels in children with human immunodeficiency virus infection. Influence of sex and age

Introducción Los estudios farmacológicos realizados demuestran una relación entre la concentración plasmática de antirretrovirales (ARV) y su toxicidad y actividad antiviral. Sin embargo, en niños con infección por el virus de la inmunodeficiencia humana (VIH), los datos farmacocinéticos y farmacodinámicos son heterogéneos y limitados. Pretendemos analizar los niveles de fármacos ARV en la práctica clínica, en niños infectados por VIH y su influencia en la efectividad terapéutica. Métodos Estudio observacional, prospectivo y multicéntrico, que incluye niños con infeccion por VIH, controlados en 5 hospitales terciarios entre marzo de 2006 y junio de 2008. Se determinó la concentración plasmática de ARV en el momento predosis y se analizó la relación con diferentes variables clínicas y analíticas. Resultados Se incluyó un total de 129 pacientes. El 41,3% presentaba niveles plasmáticos fuera del rango establecido. No se hallaron diferencias analíticas en función del género. Los menores de un año presentaban concentraciones infraterapéuticas y carga viral elevada, de modo más frecuente que el resto de los niños. Conclusión Las concentraciones plasmáticas de ARV son infraterapéuticas con mayor frecuencia en los menores de un año. Este hallazgo se relaciona con mayor fallo viral y supone un reto importante en esta población, que requiere un tratamiento a muy largo plazo (AU)

Introduction Pharmacologic studies have shown a relationship between plasma antiretroviral levels and toxicity/viral activity. Nevertheless, pharmacokinetic and pharmacodynamic data are inconsistent and limited in HIV-infected children. An analysis was performed of plasma antiretroviral concentrations in clinical practice and their influence on therapy efficacy in HIV-infected children. Methods Observational, prospective, multicenter study, including HIV-infected children followed up at 5 reference hospitals between March 2006 and June 2008. Pre-dose plasma antiretroviral levels were determined and the relationships with various clinical and analytical variables were investigated. Results A total of 129 patients were included, and 41.3% had antiretroviral plasma levels outside the established range. No differences were found between sexes. Children younger than 1 year had a higher rate of suboptimal levels and higher viral load than the remaining children. Conclusion Antiretroviral plasma concentrations are more frequently suboptimal in children younger than 1 year. This finding is related with greater viral failure and implies a considerable challenge in this population, which requires very long-term treatment (AU)

[Plasma antiretroviral levels in children with human immunodeficiency virus infection. Influence of sex and age]. / Niveles plasmáticos de antirretrovirales en niños con infección por el virus de la inmunodeficiencia humana. Influencia del género y de la edad.

INTRODUCTION: Pharmacologic studies have shown a relationship between plasma antiretroviral levels and toxicity/viral activity. Nevertheless, pharmacokinetic and pharmacodynamic data are inconsistent and limited in HIV-infected children. An analysis was performed of plasma antiretroviral concentrations in clinical practice and their influence on therapy efficacy in HIV-infected children. METHODS: Observational, prospective, multicenter study, including HIV-infected children followed up at 5 reference hospitals between March 2006 and June 2008. Pre-dose plasma antiretroviral levels were determined and the relationships with various clinical and analytical variables were investigated. RESULTS: A total of 129 patients were included, and 41.3% had antiretroviral plasma levels outside the established range. No differences were found between sexes. Children younger than 1 year had a higher rate of suboptimal levels and higher viral load than the remaining children. CONCLUSION: Antiretroviral plasma concentrations are more frequently suboptimal in children younger than 1 year. This finding is related with greater viral failure and implies a considerable challenge in this population, which requires very long-term treatment.

Utilidad del dímero D como marcador analítico en urgencias pediátricas / Utility of D-dimer level as an analytical marker in pediatric emergencies

Objetivos: Describir nuestra experiencia acerca del uso del dímero D (DD) en urgencias pediátricas. Método: Se realiza un estudio descriptivo, retrospectivo. Revisamos todas las historias clínicas de urgencias de nuestro centro en las que se realizó determinación analítica de lDD durante los años 2005 y 2006. Describimos los datos obtenidos y analizamos estadísticamente la asociación del DD con un parámetro de respuesta inflamatoria (la proteína C reactiva) mediante un estudio de correlación no paramétrico. Resultados: Los principales motivos de consulta, en las 137 historias revisadas, fueron exantema y fiebre. El DD resultó positivo en el 34,3% de los casos. No se halló correlación estadísticamente significativa entre el DD y la proteína C reactiva. El DD fue positivo en el 71% de los casos de sepsis. Conclusiones: El DD se eleva en algunos procesos inflamatorios, de manera inespecífica. Su interpretación es difícil y puede llevar a confusión. Es necesario analizarlo en su contexto clínico (AU)

Objectives: To describe our experience using D-dimer levels in attending pediatric emergencies. Methods: For this retrospective descriptive study we reviewed all emergency patient records in which D-dimer levels were measured in 2005 and 2006. We compiled descriptive statistics and analyzed the association between levels of Ddimer and C-reactive protein (as a marker of inflammatory response) using a nonparametric correlation test. Results: Rash and fever were the main reasons for attending the emergency room. The D-dimer level was elevated in34.3% of the cases. D-dimer and C-reactive protein levels were not correlated. The D-dimer level was elevated in 71% of the patients with sepsis. Conclusions: D-dimer elevation is a nonspecific marker in certain inflammatory processes. It is difficult to interpret, may lead to confusion, and should be read in a manner that is consistent with the clinical context. Prospective studies are needed to provide evidence of its utility as a marker in acute conditions in children (AU)

Evolutive study of children with diffuse mesangial sclerosis.

Diffuse mesangial sclerosis (DMS) is a renal disease that usually presents as a nephrotic syndrome. It is characterized by early onset and rapid progression to end-stage renal disease, and can occur as an isolated finding or as part of the Denys-Drash syndrome. The aim of this study was to characterize clinical features and outcomes of DMS in a cohort of children. We retrospectively analyzed all cases of DMS diagnosed in our hospital between 1973 and 2008 and evaluated the progression of the disease in relation to different variables. We studied 14 patients, four with incomplete Denys-Drash syndrome and one with Frasier syndrome. All patients developed renal failure. Eight patients received a renal transplant with no relapse of the disease. Bilateral nephrectomy was performed in nine patients with end-stage renal disease. Seven patients died, with sepsis being the main cause of death. Diffuse mesangial sclerosis must be suspected in a child that presents with early onset proteinuria and/or rapidly progressive renal failure. Karyotype and WT1 gene analysis should be performed because of the predisposition of patients to develop different types of tumors. This nephropathy has a poor prognosis, but the survival rate has improved in the last decade.

Pathology in children of HIV women.

OBJECTIVE: To assess the frequency of perinatal pathology in children exposed to antiretrovirals in perinatal period. DESIGN: Retrospective observational cohort study. METHODS: Retrospective observational cohort study. Data collected among uninfected children born to HIV-infected women followed up from 1994 to 2006 in a tertiary Hospital. 220 uninfected children were studied. Factors studied included maternal, obstetrical and pediatric variables. RESULTS: The most common disorder found among children exposed to antiretroviral drugs was anemia (84%); 6,4% of children had neutropenia and more than 24% had thrombocytosis, a finding never described before. Prematurity (24%) and low birth weight (23.6%) rates were high. Several congenital malformations were found: Poland syndrome, angiomas, hypospadias, Pierre-Robin sequence, trisomy 8, craniostosis and others. Long-term follow-up revealed neurological, cardiological and ophthalmological pathologies. CONCLUSION: Some pathologies are frequent among children exposed to antiretroviral agents during perinatal life. It is crucial to carry out long-term studies to assess the safety of this therapy.