Características de los debuts diabéticos en los niños ingresados en un hospital terciario durante diez años / Characteristics of diabetic debuts in children admitted to a tertiary hospital for ten years

Introducción. La diabetes mellitus tipo 1 constituye unade las patologías crónicas más frecuentes en la infancia. Suincidencia está sufriendo un incremento en los últimos años.Objetivo. Describir y analizar las características epidemiológicas, clínicas, analíticas y terapéuticas en el momentodel debut de la enfermedad, comparándolas entre gruposde edad de los pacientes que debutan con DM1 en nuestraprovincia.Pacientes y métodos. Estudio observacional retrospectivo mediante revisión de historias clínicas de pacientesmenores de 14 años con debut de diabetes tipo 1 entre 2007y 2017 en un hospital de tercer nivel. La muestra se dividiópor edades en tres grupos (0-4 años, 5-9 años,10-14 años).Resultados. Se recogieron 64 pacientes con edad mediade 8,15 años (DE 3,41), el 48,4% entre 5-9 años. No se hallarondiferencias de sexo ni patrón estacional, aunque los pacientesde menor edad debutaron más frecuentemente en invierno.No se observó aumento en la incidencia con el tiempo nidiferencias en los síntomas entre grupos. Debutaron concetoacidosis diabética el 36%, fundamentalmente leves.Encontramos un porcentaje menor de anticuerpos IAA yantiGAD de lo esperado y mayor frecuencia de antecedentesfamiliares positivos. Se observó correlación lineal positivaentre las cifras de bicarbonato y cuerpos cetónicos en sangrey las necesidades de insulina por kg de peso (p 0,025 y p0,05, respectivamente). Los niños de menor edad presentanniveles de HbA1c más bajos al inicio de la enfermedad.Conclusiones. En nuestro medio no se está produciendoun aumento en el número de casos de esta enfermedad, aunque los mismos se concentran a menor edad de la esperada (AU)

Introduction. Type 1 diabetes mellitus is one of the mostfrequent chronic pathologies in childhood. Its incidence hasincreased in the last years.Objective. To analyze the epidemiological, clinical,analytical and therapeutic characteristics at the time of thedisease’s onset, and to compare them between age groupsof those patients with Diabetes mellitus type 1 in our region.Patients and methods. Retrospective observational studyby reviewing the medical records of patients under 14 yearsof age with onset of type 1 diabetes between 2007 and 2017in a tertiary-level hospital. The sample was divided by ageinto three groups (0-4 years, 5-9 years,10-14 years).Results. 64 patients were studied, the mean age was8.15 years (SD 3.41), 48.4% of them between 5-9 years. Nodifferences in sex or seasonal pattern were found, althoughyounger children became ill more frequently in winter. There was no increase in incidence over time ordifferencesin symptoms between groups. 36% debuted with diabeticketoacidosis, mainly mild. We found a lower percentage ofIAA and antiGAD antibodies than expected and a higherfrequency of positive family history. A positive linear correlation was observed between the levels of bicarbonateand ketone bodies in blood and the insulin needs per kg ofweight (p 0.025 and p 0.05 respectively). Younger childrenhave lower HbA1c levels at the beginning of the disease.Conclusions. In our centre there is not an increase in thenumber of cases of this disease, although we found morecases at a younger age than expected. (AU)

Tratamiento de la obesidad en la consulta de endocrinología de un hospital. Influencia del índice de masa corporal de los padres / Treatment of obesity in a hospital endocrinology clinic. Influence of parental body mass index

Introducción: El objetivo del estudio es conocer si tener padres obesos influye en la adherencia y el éxito del tratamiento frente a la obesidad en la consulta de endocrinología infantil de un hospital. Material y métodos: Estudio analítico, prospectivo y longitudinal en obesos de 4-14 años. En ellos se determinó el IMC inicial y 6 meses después de que recibieran pautas higiénico-dietéticas saludables. Se consideró éxito significativo la disminución de 0,5 DE del IMC y adherencia que los pacientes acudieran a la revisión semestral. Se calculó el IMC de los padres para identificar a los obesos. Se utilizó el test de la χ2 para comparar las variables cualitativas y el test de la t de Student para las variables cuantitativas (significativo: p<0,05). Resultados: Cien niños (52 varones), edad media ± DE: 9,9±2,7 años, IMC 28,1±4,5kg/m2 y Z-score del IMC 3,11 ± 0,98 (el 85% tenía un Z-score del IMC > 3). Eran obesos 41 padres y 38 madres (el 59% tenía uno o los 2 padres obesos). No se adhirieron al tratamiento 25. La adherencia era peor si los 2 padres eran obesos, OR 3,65 (1,3-10,5) (p = 0,01) y era mejor si la madre no era obesa, aunque el padre lo fuera (p=0,01). El tratamiento tuvo éxito significativo en 40 pacientes. Si la madre era la única obesa en la familia la posibilidad de no tener éxito era mayor, OR 5,6 (1,4-22,4) (p<0,01). Conclusiones: Un alto porcentaje de niños con obesidad severa tienen padres obesos. La madre tiene gran influencia en la adherencia y respuesta al tratamiento frente a la obesidad del hijo muy obeso (AU)

Introduction: Parental obesity is a risk factor for childhood obesity. The aim of this study was to determine if parental obesity influences the adherence and success of obesity treatment in a hospital paediatric endocrinology clinic. Material and methods: An analytical, prospective, longitudinal study was conducted on obese children aged 4-14. An initial body mass index (BMI), and again at 6 months after receiving health, hygiene and dietary recommendations. Success was considered as a decrease of 0.5 in the BMI Z-score, and adherence to attending the 6-month review. Parental BMI was determined to identify overweight. The χ2 test was used for qualitative variables and the T-Student test for quantitative (significance, p<<.05). Results: The study included 100 children (52 male), 9.9±2.7 years old, BMI 28.1± 4.5kg/m2 and BMI Z-Score 3.11±0.98. (85% had a BMI Z-score>3). More than half (59%) of the children had one or both parents obese (41 fathers and 37 mothers were obese). Treatment was not adhered to by 25 children. Adherence was worse if both parents were obese OR 3.65 (1.3 to 10.5) (P<=.01) and adherence was better if the mother was not obese, although the father was (P=.01). The treatment had significant success in 40 patients. If the mother was the only obese one in the family, the possibility of treatment failure was greater OR 5.6 (1.4 to 22.4)(P<.01). Conclusions: A high percentage of children with severe obesity have obese parents. The mother has an important influence on adherence and response to treatment for the severely obese child (AU)

[Treatment of obesity in a hospital endocrinology clinic. Influence of parental body mass index]. / Tratamiento de la obesidad en la consulta de endocrinología de un hospital. Influencia del índice de masa corporal de los padres.

INTRODUCTION: Parental obesity is a risk factor for childhood obesity. The aim of this study was to determine if parental obesity influences the adherence and success of obesity treatment in a hospital paediatric endocrinology clinic. MATERIAL AND METHODS: An analytical, prospective, longitudinal study was conducted on obese children aged 4-14. An initial body mass index (BMI), and again at 6 months after receiving health, hygiene and dietary recommendations. Success was considered as a decrease of 0.5 in the BMI Z-score, and adherence to attending the 6-month review. Parental BMI was determined to identify overweight. The χ(2) test was used for qualitative variables and the T-Student test for quantitative (significance, p<<.05). RESULTS: The study included 100 children (52 male), 9.9±2.7 years old, BMI 28.1± 4.5kg/m(2) and BMI Z-Score 3.11±0.98. (85% had a BMI Z-score>3). More than half (59%) of the children had one or both parents obese (41 fathers and 37 mothers were obese). Treatment was not adhered to by 25 children. Adherence was worse if both parents were obese OR 3.65 (1.3 to 10.5) (P<=.01) and adherence was better if the mother was not obese, although the father was (P=.01). The treatment had significant success in 40 patients. If the mother was the only obese one in the family, the possibility of treatment failure was greater OR 5.6 (1.4 to 22.4) (P<.01) CONCLUSIONS: A high percentage of children with severe obesity have obese parents. The mother has an important influence on adherence and response to treatment for the severely obese child.

Reducing errors in the management of hyperbilirubinaemia: validating a software application.

OBJECTIVE: To verify the usefulness and reliability of a software tool we developed to help to apply the American Academy of Pediatrics (AAP) Guidelines 2004 on hyperbilirubinaemia according to the infant's age in hours and their clinical risk factors. DESIGN: Randomised, cross-over, controlled trial with 20 simulated clinical cases comparing the "manual" application of the guidelines with our software application. PARTICIPANTS: Fifteen doctors (eight final-year residents and seven consultants) from two hospitals in Spain. MAIN OUTCOME MEASURES: Major errors (defined a priori as any deviation from the AAP guidelines that involve a risk of morbidity or mortality for the patient), minor errors (those that cause discomfort and/or, in extremely rare cases, morbidity) and time spent. RESULTS: Fifteen doctors each managed 20 simulated cases, half by using the guidelines alone and half using the software tool. Without the software application, 42 "minor" errors were made. With it, only 25 errors were made. "Major" errors also decreased from 10 to 2 with the software. As a group, the residents benefited most; they made an average of 1.8 errors fewer per 10 cases. Use of the software reduced the time taken by the residents to resolve the cases, although the mean reduction in time was not significant for the group of consultants. CONCLUSIONS: The use of simulated clinical cases revealed many errors in the routine management of hyperbilirubinaemia. The software helped clinicians make fewer errors and saved time for residents, but not consultants.

Síndrome de megavejiga-microcolon-hipoperistaltismo intestinal / Megabladder-microcolon-intestinal hypoperistaltism syndrome

El síndrome de megavejiga-microcolon-hipoperistaltismo intestinal es una causa rara, grave y congénita de obstrucción intestinal funcional neonatal que además puede llevar asociadas otras alteraciones. Actualmente sigue siendo difícil el diagnóstico prenatal de certeza y debe hacerse diagnóstico diferencial con problemas obstructivos. Al nacimiento se presenta con clínica de obstrucción intestinal y retención urinaria, precisando de pruebas complementarias para la confirmación diagnóstica. En el manejo de estos pacientes es fundamental el soporte nutricional que en muchas ocasiones se basa en nutrición parenteral durante largos periodos de tiempo. A pesar de la mejoría en la asistencia a estos pacientes, este síndrome sigue presentando una elevada morbilidad y mortalidad siendo el trasplante intestinal una alternativa terapéutica. Se presenta a continuación el caso de un paciente que actualmente tiene 6 meses y recibe nutrición enteral a débito continuo suplementada con nutrición parenteral domiciliaria con buena ganancia ponderal y aceptable calidad de vida (AU)