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)

Enfermedad celíaca, ¿puede ser una emergencia quirúrgica? / Celiac disease, can it be a surgical emergency?

Existe una gran variabilidad de manifestaciones clínicas en la enfermedad celíaca, predominando en la edad pediátrica la diarrea, el dolor y la distensión abdominal, la irritabilidad o el estancamiento ponderoestatural. Paciente de 4 años con aparición súbita de intenso dolor abdominal, mal estado general, abdomen marcadamente distendido y a tensión. La ecografía abdominal resulta poco valorable. Se realiza TC urgente que muestra una importante dilatación del marco cólico e intestino delgado. Se decide actitud expectante. Historiando a los padres refieren diarrea y episodios de dolor abdominal los últimos meses, anemia y elevación de anticuerpos antitransglutaminasa IgA en analítica solicitada por su pediatra. Durante el ingreso se completa diagnóstico de enfermedad celíaca. Aunque la distensión abdominal es un hallazgo frecuente en los pacientes celíacos, su presentación en forma de abdomen agudo es muy inusual y sugiere como primera posibilidad una emergencia medico-quirúrgica. La prueba de imagen permitió adoptar una actitud expectante y realizar un diagnóstico correcto

There is great variability of clinical manifestations in celiac disease, predominating in childhood diarrhea, abdominal distension and pain, irritability or and failure to thrive. Patient 4 years old. Sudden onset of severe abdominal pain, malaise, striking abdominal distension and tension. Abdominal ultrasound is difficult to assess. TC scan show a significant expansion of colonic frame and small intestine. Conservative management was decided. Parents relate diarrhea and abdominal pain in the last months, anemia and raising transglutaminase IgA antibodies in analytical requested by his pediatrician. During admission diagnosis of celiac disease is complete. Although abdominal distension is a common finding in celiac patients, their presentation as acute abdomen is very unusual and suggests as a first option a medical-surgical emergency. The imaging allowed to adopt an expectant attitude and make a correct diagnosis

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)

Trastorno del desarrollo de la coordinación / Developmental coordination disorder

Durante varios años, muchos niños sin comorbilidad neurológica grave que presentaban un desarrollo motor subóptimo o con dificultades motrices en áreas específicas como la coordinación visomotora o el equilibrio eran etiquetados como 'torpes', con 'dispraxia' o 'trastornos motores menores'. En 1994, este tipo de trastornos se unificaron bajo el término único de 'trastorno del desarrollo de la coordinación'; sin embargo, actualmente sigue constituyendo una patología poco conocida y a menudo infradiagnosticada. Se estima que entre un 5-8% de niños en la etapa escolar podrían tener trastorno del desarrollo de la coordinación, con un mayor predominio en el sexo masculino. Este riesgo es significativamente superior en los niños prematuros, incluso en aquellos sin secuelas neurológicas aparentes. Las manifestaciones clínicas vienen determinadas por la combinación de una alteración en la propiocepción, la programación motora y la actividad motora secuencial, lo que conlleva dificultades en diferentes áreas motrices, que repercuten en las actividades de la vida diaria, el rendimiento académico y la autoestima. Existen herramientas diagnósticas específicas para su detección. La evolución clínica sin tratamiento específico suele ser la cronificación de las disabilidades motrices, por lo que el diagnóstico y el tratamiento precoz resultan de especial interés en estos niños

Over several years, many children without severe neurological comorbidity having suboptimal motor development or motor difficulties in specific areas such as visomotor coordination or balance were labels as 'clumsy,' with 'dyspraxia' or 'minor motor disorders.' In 1994, this type of disorder was unified under the term 'developmental coordination disorder.' However, it continues to be a little known condition and is often underdiagnosed. It is estimated that 5-8% of school age children could have developmental coordination disorder, with a greater predominance in the male gender. This risk is significantly greater in premature children, even in those without apparent neurological sequels. The clinical manifestations are determined by the combination of an alteration in propioception, motor programming and sequential motor activity. This entails difficulties in different motor areas that affect the daily life activities, academic performance and self esteem. There are specific diagnostic tools for their detection. The clinical course without specific treatment generally leads to the chronification of the motor disabilities, so that the early diagnosis and treatment is of special importance in these children

Colestasis y pancreatitis como forma de presentación de quiste de colédoco forma frustra / A forme fruste choledochal cyst presenting as cholestasis and pancreatitis

No disponible

[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.

Utilidad de la ecografía comparada con la capnografía y la radiografía en la intubación traqueal / Usefulness of bedside ultrasound compared to capnography and X-ray for tracheal Intubation

OBJETIVOS: Evaluar la utilidad de la ecografía frente a la capnografía y la radiografía en la intubación traqueal (IT) en niños y neonatos. MATERIAL Y MÉTODOS: Se incluyó a pacientes hemodinámicamente estables intubados en la UCIP y UCIN. Se verificó la posición del tubo endotraqueal (TET) tras cada intubación mediante ecografía traqueal y capnografía. Posteriormente, se comprobó la profundidad del TET por ecografía mediante la visualización de la punta del mismo y el deslizamiento pleural y, posteriormente, con radiografía de tórax. Se cronometraron los tiempos de realización de las técnicas. RESULTADOS: Se incluyó a 31 intubaciones en 26 pacientes (15 en UCIP y 16 en UCIN). No hubo diferencias significativas entre la ecografía y la capnografía ni entre la ecografía y la radiografía en la detección de la IT ni en la comprobación de la profundidad del TET. La sensibilidad y la especificidad de la ecografía comparada con la capnografía y la radiografía fueron del 92 y el 100%, y del 100 y el 75%, respectivamente. La ecografía fue significativamente más lenta que la capnografía (12 [4-16] vs. 6 [3-12] s; p < 0,001) y más rápida que la radiografía (0,22 [0,17-0,40] vs. 20 [17-25] min; p < 0,001). CONCLUSIONES: La ecografía parece tan efectiva como la capnografía, aunque más lenta en la comprobación de la IT. Podría ser de utilidad en situaciones donde la capnografía no sea fiable. La ecografía es tan efectiva y más rápida que la radiografía en la evaluación de la profundidad del TET, por lo que podría disminuir la utilización rutinaria de la radiografía

OBJECTIVES: The aim of this study was to assess the usefulness of bedside ultrasound compared to capnography and X-ray for endotracheal intubation in children and newborns. MATERIALS AND METHODS: Hemodynamically stable children intubated in pedriatric and neonatal intensive care unit were included. Endotracheal tube insertion was checked after every intubation attempt by tracheal ultrasound and capnography simultaneously. The endotracheal tube insertion depth was then checked by assesment of lung sliding by thoracic ultrasound. Thereafter, Chest X-ray was performed and interpreted as usual. Time to perform each technique was recorded. RESULTS: The study included 31 intubations in 26 patients (15 in PICU and 16 in NICU). There were no statistically significant differences between tracheal ultrasound and capnography or between thoracic ultrasound and x-ray in identifying the correct endotracheal intubation and assessment of endotracheal tube insertion depth, respectively. Sensibility and specificity of ultrasound compared to capnography was 92% and 100%, and 100% and 75% compared to X-ray. Ultrasound was significantly slower compared to capnography [12 (4-16) vs 6 (3-12) seconds; P<.001] and significantly quicker compared to X-ray [0.22 (0.17-0.40) vs. 20 (17-25) minutes, P<.001]. CONCLUSIONS: Ultrasound appears to be as effective as capnography, although slower, for identifying endotracheal intubation. Ultrasound may be useful in clinical situations, such as cardiopulmonary resuscitation where capnography is less reliable. Ultrasound is as effective and quicker than X-ray for assessment of endotracheal tube insertion depth, and it may contribute to decrease the routine use of X-ray after tracheal intubation

Hipertiroidismo neonatal e hipertensión pulmonar / Neonatal hyperthyroidism and pulmonary hypertension

No disponible

[Usefulness of bedside ultrasound compared to capnography and X-ray for tracheal intubation]. / Utilidad de la ecografía comparada con la capnografía y la radiografía en la intubación traqueal.

OBJECTIVES: The aim of this study was to assess the usefulness of bedside ultrasound compared to capnography and X-ray for endotracheal intubation in children and newborns. MATERIALS AND METHODS: Hemodynamically stable children intubated in pedriatric and neonatal intensive care unit were included. Endotracheal tube insertion was checked after every intubation attempt by tracheal ultrasound and capnography simultaneously. The endotracheal tube insertion depth was then checked by assesment of lung sliding by thoracic ultrasound. Thereafter, Chest X-ray was performed and interpreted as usual. Time to perform each technique was recorded. RESULTS: The study included 31 intubations in 26 patients (15 in PICU and 16 in NICU). There were no statistically significant differences between tracheal ultrasound and capnography or between thoracic ultrasound and x-ray in identifying the correct endotracheal intubation and assessment of endotracheal tube insertion depth, respectively. Sensibility and specificity of ultrasound compared to capnography was 92% and 100%, and 100% and 75% compared to X-ray. Ultrasound was significantly slower compared to capnography [12 (4-16) vs 6 (3-12) seconds; P<.001] and significantly quicker compared to X-ray [0.22 (0.17-0.40) vs. 20 (17-25) minutes, P<.001]. CONCLUSIONS: Ultrasound appears to be as effective as capnography, although slower, for identifying endotracheal intubation. Ultrasound may be useful in clinical situations, such as cardiopulmonary resuscitation where capnography is less reliable. Ultrasound is as effective and quicker than X-ray for assessment of endotracheal tube insertion depth, and it may contribute to decrease the routine use of X-ray after tracheal intubation.

Test de elevación pasiva de las piernas y respuesta a líquidos en un niño politraumatizado / Passive leg raising test and fluid responsiveness in a child with multiple injuries

No disponible

Tos ferina y parada cardiorrespiratoria secundaria a bradicardia durante accesos de tos / Whooping cough and cardiorespiratory arrest secondary to a bradycardia during coughing spells

No disponible

Asociación entre gastroenteritis aguda leve y convulsiones afebriles benignas / Association between mild acute gastroenteritis and benign afebrile convulsions

Introducción: La presentación de convulsiones benignas febriles durante una gastroenteritis leve sin deshidratación ni fiebre ni alteraciones electrolíticas es una asociación descrita con relativa frecuencia en Asia, siendo más desconocida fuera del continente asiático. Casos clínicos: Se describen las características de cuatro casos de lactantes que ingresaron en nuestro hospital por presentar convulsiones a febriles asociadas a gastroenteritis agudas. En tres de los cuatro casos se identificó la presencia de Rotavirus en heces y en todos los casos la evolución ha sido favorable. Comentarios: Probablemente, esta entidad es infradiagnosticada en nuestro país. Reconocer esta entidad debe servirnos para evitar tratamientos antiepilépticos prolongadose intensos (AU)

Introduction: The presentation of benign seizures afebriles in association a slight gastroenteritis without dehydration or fever or electrolytic imbalance is an association described with relative frequency in Asia, not being more known out of the Asian continent. Case reports: There are described the characteristics off our cases who joined our hospital for presenting convulsions afebriles associated with gastroenteritis acute. In three of four cases Rotavirus’s presence was identified in dregs and in all the cases the evolution has been favorable. Conclusions: Probably this entity is infradiagnosticada in our country. To recognize ourselves this entity must serve to avoid anti-epileptic long and intense (AU)