Síndrome hemolítico-urémico: afectación renal a largo plazo / Hemolytic uremic syndrome: long term renal injury

Introducción: El síndrome hemolítico urémico es la causa más frecuente de insuficiencia renal aguda no prerrenal en edad pediátrica y suele ser secundario a diarrea aguda infecciosa, generalmente por Escherichia coli productor de verotoxina. Se caracteriza por fracaso renal agudo, anemia hemolítica y trombocitopenia. Puede producir secuelas renales a largo plazo y llevar a insuficiencia renal terminal. Material y métodos: El objetivo de este estudio retrospectivo es describir las secuelas renales y analizar los factores pronósticos de las mismas en los pacientes pediátricos atendidos en un hospital terciario español en los últimos 28 años. Resultados: Han sido atendidos 43 niños con esta patología, 38 de ellos con antecedentes de diarrea. Entre los seguidos más de 3 meses, en el momento de la última revisión (media 6,6 años, DE 5 años de seguimiento), un 21,6% (8/37) presentaba deterioro del filtrado glomerular. Incluyendo proteinuria e hipertensión arterial, encontramos hasta un 35,1% (13/37) de enfermedad renal crónica. Un 8,1% (3/37) entró en insuficiencia renal terminal. Encontramos como factores pronósticos de lesión renal a largo plazo en regresión logística univariante: hipertensión durante el ingreso, mayor leucocitosis, mayor duración del ingreso, mayor duración de la anuria y menor filtrado glomerular al alta. El análisis multivariante muestra asociación con la duración de la anuria. Conclusiones: Aproximadamente, una tercera parte de nuestros casos de síndrome hemolítico-urémico desarrollaron a largo plazo afectación renal en grado variable. Una mayor y más prolongada afectación de la función renal inicial se asocia en nuestro estudio con una mayor probabilidad de deterioro renal en su evolución posterior (AU)

Introduction: Hemolytic uremic syndrome (HUS) is the most frequent cause of non-pre-renal acute renal failure in pediatrics and it is usually secondary to acute infectious diarrhea, generally due to Shiga-toxin producing E. coli. It is characterized by acute renal failure, hemolytic anemia and thrombocytopenia. It can lead to renal sequels in the long term and to end-stage renal disease. Methods: The aim of this retrospective study is to describe and analyze renal sequels and their prognostic factors in pediatric patients suffering from HUS in a Spanish tertiary hospital during the last 28 years. Results: 43 children with this condition were admitted, with 38 of them having presented with diarrhea previously. Among those with a follow-up longer than 3 months, 21.6% (8/37) had a reduction in glomerular filtration rate (GFR) in the last visit. Including proteinuria and hypertension, we found up to 35.1% (13/37) prevalence of chronic kidney disease, with 8.1% (3/37) of the patients with end-stage renal disease. We found the following to be prognostic factors for renal injury in the long term in a univariate logistic regression: hypertension, a longer stay in the hospital, more prolonged anuria, more severe leukocytosis and lower GFR at discharge. Multivariate logistic regression showed an association with time in anuria. Conclusions: Approximately one third of our cases of hemolytic uremic syndrome developed some degree of chronic kidney disease in the long term. A deeper and longer initial renal disfunction is associated with a higher probability of subsequent renal problems (AU)

[Hemolytic uremic syndrome: long term renal injury]. / Síndrome hemolítico-urémico: afectación renal a largo plazo.

INTRODUCTION: Hemolytic uremic syndrome (HUS) is the most frequent cause of non-pre-renal acute renal failure in pediatrics and it is usually secondary to acute infectious diarrhea, generally due to Shiga-toxin producing E. coli. It is characterized by acute renal failure, hemolytic anemia and thrombocytopenia. It can lead to renal sequels in the long term and to end-stage renal disease. METHODS: The aim of this retrospective study is to describe and analyze renal sequels and their prognostic factors in pediatric patients suffering from HUS in a Spanish tertiary hospital during the last 28 years. RESULTS: 43 children with this condition were admitted, with 38 of them having presented with diarrhea previously. Among those with a follow-up longer than 3 months, 21.6% (8/37) had a reduction in glomerular filtration rate (GFR) in the last visit. Including proteinuria and hypertension, we found up to 35.1% (13/37) prevalence of chronic kidney disease, with 8.1% (3/37) of the patients with end-stage renal disease. We found the following to be prognostic factors for renal injury in the long term in a univariate logistic regression: hypertension, a longer stay in the hospital, more prolonged anuria, more severe leukocytosis and lower GFR at discharge. Multivariate logistic regression showed an association with time in anuria. CONCLUSIONS: Approximately one third of our cases of hemolytic uremic syndrome developed some degree of chronic kidney disease in the long term. A deeper and longer initial renal disfunction is associated with a higher probability of subsequent renal problems.

[Pyomyositis in children: not only a tropical disease]. / Piomiositis en los niños: no sólo una enfermedad tropical.

INTRODUCTION: Pyomyositis is an acute bacterial infection of skeletal striated muscle typical of tropical countries but infrequent in our environment. The present review aims to describe the clinical characteristics, epidemiology, etiology, diagnosis and outcome of patients with pyomyositis in our hospital. MATERIAL AND METHODS: The medical records of patients diagnosed with pyomyositis in our hospital from 2002 to 2005 were reviewed. Epidemiological, clinical, and microbiological data as well as the diagnostic tests and treatment strategies used were gathered and a descriptive analysis was performed. RESULTS: There were seven patients (five boys and two girls). The mean age of the patients was 8.6 years. Five patients (70%) presented during the 6 warmer months. There were four secondary cases (one HIV infection, three musculoskeletal injuries). The most frequent sites were the psoas-iliac region and thigh. The main symptoms at presentation were pain and fever. The most common diagnostic imaging modality was ultrasound examination, although magnetic resonance imaging had the highest diagnostic yield (sensitivity of 100% versus 33% for ultrasound). The most prevalent microorganism in our series was Staphylococcus aureus (found in three out of seven patients). Only two abscesses were surgically drained and the remainder were treated with antibiotics alone, first intravenously (mean of 17 days) and then orally (mean of 26 days). None of our patients developed sequelae. CONCLUSIONS: Pyomyositis should be included in the differential diagnosis in children with fever, pain and/or functional impotence, even though this entity is infrequent in our environment. The most sensitive diagnostic test is magnetic resonance imaging. With early diagnosis and correct treatment, outcome is good.

Piomiositis en los niños: no sólo una enfermedad tropical / Pyomyositis in children: not only a tropical disease

Introducción La piomiositis es una infección bacteriana aguda del músculo esquelético estriado, típica de países tropicales pero infrecuente en España. El objetivo de esta revisión es describir las características clínicas, epidemiológicas, etiológicas y diagnósticas en pacientes afectados de piomiositis. Material y métodos Se revisaron las historias de los pacientes diagnosticados de piomiositis en nuestro centro entre 2002 y 2005, recogiendo variables epidemiológicas, clínicas, analíticas, microbiológicas, terapéuticas y medios de diagnóstico. Se realizó un análisis descriptivo de las mismas. Resultados Se recogieron 7 casos (5 varones y 2 mujeres). La media de edad fue 8,6 años. Cinco de los casos (70 %) ocurrieron en los 6 meses de más calor. Hubo cuatro casos secundarios (una infección por el virus de la inmunodeficiencia humana, tres con antecedente traumático). Las localizaciones más frecuentes fueron la región del iliopsoas y el muslo. El dolor y la fiebre fueron los principales síntomas de inicio. La prueba de imagen más utilizada fue la ecografía, si bien la más rentable resultó ser la resonancia magnética, con una sensibilidad del 100 % frente al 33 % de la primera. El germen de mayor prevalencia en nuestra serie fue el Staphylococcus aureus (3/7). Sólo dos abscesos se drenaron quirúrgicamente y el resto se trató exclusivamente con antibioterapia, primero intravenosa seguida de oral. Ninguno de nuestros pacientes ha presentado secuelas. Conclusiones Ante todo niño con fiebre, dolor y/o impotencia funcional debemos considerar la piomiositis como posible entidad dentro del diagnóstico diferencial, a pesar de que ésta sea una enfermedad poco frecuente en España. La prueba diagnóstica más rentable es la RM. Si el tratamiento se realiza de forma precoz y eficaz, la evolución es buena

Introduction Pyomyositis is an acute bacterial infection of skeletal striated muscle typical of tropical countries but infrequent in our environment. The present review aims to describe the clinical characteristics, epidemiology, etiology, diagnosis and outcome of patients with pyomyositis in our hospital. Material and methods The medical records of patients diagnosed with pyomyositis in our hospital from 2002 to 2005 were reviewed. Epidemiological, clinical, and microbiological data as well as the diagnostic tests and treatment strategies used were gathered and a descriptive analysis was performed. Results There were seven patients (five boys and two girls). The mean age of the patients was 8.6 years. Five patients (70 %) presented during the 6 warmer months. There were four secondary cases (one HIV infection, three musculoskeletal injuries). The most frequent sites were the psoas-iliac region and thigh. The main symptoms at presentation were pain and fever. The most common diagnostic imaging modality was ultrasound examination, although magnetic resonance imaging had the highest diagnostic yield (sensitivity of 100 % versus 33 % for ultrasound). The most prevalent microorganism in our series was Staphylococcus aureus (found in three out of seven patients). Only two abscesses were surgically drained and the remainder were treated with antibiotics alone, first intravenously (mean of 17 days) and then orally (mean of 26 days). None of our patients developed sequelae. Conclusions Pyomyositis should be included in the differential diagnosis in children with fever, pain and/or functional impotence, even though this entity is infrequent in our environment. The most sensitive diagnostic test is magnetic resonance imaging. With early diagnosis and correct treatment, outcome is good

[Residents in pediatrics in primary care centers: 5 years of compulsory rotation in Health Area 11 of Madrid]. / Residentes de Pediatría en Atención Primaria: 5 años de rotación obligatoria en el Area 11 de Madrid.

INTRODUCTION: Currently, primary care center rotation is not compulsory for residents in pediatrics. The aim of this study was to describe the experience of tutors and residents during primary care rotation, which has been compulsory for residents in the Hospital 12 Octubre in Madrid for the last 5 years. METHODS: We performed an observational, descriptive, cross-sectional study through a survey carried out in June 2005 of 12 accredited tutors and 38 residents. RESULTS: Sixty-eight percent of the residents did not know how primary care centers worked. Eighty-four percent of the residents considered that the first year of residence was the best year for rotation in primary care, 64% would choose the center according to the tutor, and 97% highlighted the teaching of the tutors. Tutors and residents believed that the length of the rotation (1.5 months) was short. All tutors and residents thought that the main objectives were achieved and recognized the importance of the rotation. Tutors found teaching gratifying and all agreed that their work should be compensated by professional recognition or greater access to training. Coordination with the hospital's pediatric teaching board should be improved. CONCLUSIONS: Compulsory rotation in primary care is feasible and is a positive component of pediatrics training. Residents and tutors considered this experience to be satisfactory and well adapted to the established objectives. The position of teaching coordinator should be created in primary care, the length of rotations prolonged and tutors' work should be compensated.

Residentes de Pediatría en Atención Primaria: 5 años de rotación obligatoria en el Área 11 de Madrid / Residents in pediatrics in primary care centers: 5 years of compulsory rotationin Health Area 11 of Madrid

Introducción Actualmente, la rotación por Atención Primaria de los Residentes de Pediatría no se realiza de forma sistemática. El objetivo de este estudio es dar a conocer la experiencia de tutores y residentes en relación a esta rotación, que desde hace 5 años es obligatoria para los residentes del Hospital 12 de Octubre de Madrid. Métodos Estudio observacional, descriptivo, transversal, realizado mediante encuesta en junio de 2005 a los 12 tutores acreditados y a los 38 residentes que han rotado. Resultados El 68 % de los residentes no conocía el funcionamiento de los Centros de Salud. Consideraron el primer año como el mejor para la rotación el 84 %. Un 65 % elegirían el Centro en función del tutor y el 97 % destacaba la implicación docente del mismo. Tutores y residentes opinaron que era escasa la duración (mes y medio). Todos creían que se alcanzaban los objetivos generales y reconocían la importancia de la rotación. Los tutores vivieron su labor docente como gratificante y estaban de acuerdo en que se debería compensar con reconocimiento profesional o mayor accesibilidad docente. Sería deseable mejorar la coordinación con la comisión de docencia de Pediatría del Hospital. Conclusiones La rotación rutinaria por Atención Primaria es posible y una experiencia positiva para la formación del pediatra. Residentes y tutores consideran que es satisfactoria y se ajusta a los objetivos marcados. Sería deseable crear la figura en Primaria de un coordinador docente, mayor duración de la rotación y alguna forma de reconocimiento a la labor de tutor

Introduction Currently, primary care center rotation is not compulsory for residents in pediatrics. The aim of this study was to describe the experience of tutors and residents during primary care rotation, which has been compulsory for residents in the Hospital 12 Octubre in Madrid for the last 5 years. Methods We performed an observational, descriptive, cross-sectional study through a survey carried out in June 2005 of 12 accredited tutors and 38 residents. Results Sixty-eight percent of the residents did not know how primary care centers worked. Eighty-four percent of the residents considered that the first year of residence was the best year for rotation in primary care, 64 % would choose the center according to the tutor, and 97 % highlighted the teaching of the tutors. Tutors and residents believed that the length of the rotation (1.5 months) was short. All tutors and residents thought that the main objectives were achieved and recognized the importance of the rotation. Tutors found teaching gratifying and all agreed that their work should be compensated by professional recognition or greater access to training. Coordination with the hospital's pediatric teaching board should be improved. Conclusions Compulsory rotation in primary care is feasible and is a positive component of pediatrics training. Residents and tutors considered this experience to be satisfactory and well adapted to the established objectives. The position of teaching coordinator should be created in primary care, the length of rotations prolonged and tutors' work should be compensated