Use of eltrombopag for secondary immune thrombocytopenia in clinical practice.

Eltrombopag is a second-line treatment in primary immune thrombocytopenia (ITP). However, its role in secondary ITP is unknown. We evaluated the efficacy and safety of eltrombopag in secondary ITP in daily clinical practice. Eighty-seven secondary ITP patients (46 with ITP secondary to autoimmune syndromes, 23 with ITP secondary to a neoplastic disease subtype: lymphoproliferative disorders [LPDs] and 18 with ITP secondary to viral infections) who had been treated with eltrombopag were retrospectively evaluated. Forty-four patients (38%) had a platelet response, including 40 (35%) with complete responses. Median time to platelet response was 15 days (95% confidence interval, 7-28 days), and was longer in the LPD-ITP group. Platelet response rate was significantly lower in the LPD-ITP than in other groups. However, having achieved response, there were no significant differences between the durable response of the groups. Forty-three patients (49·4%) experienced adverse events (mainly grade 1-2), the commonest being hepatobiliary laboratory abnormalities. There were 10 deaths in this case series, all of which were related to pre-existing medical conditions. In routine clinical practice, eltrombopag is effective and well-tolerated in unselected patients with ITP secondary to both immune and infectious disorders. However, the response rate in LPD-ITP is low.

Prevalence of overweight and obesity in child population. A study of a cohort in Castile and Leon, Spain. / Prevalencia de sobrepeso y obesidad infantil. Estudio de una cohorte en Castilla y León, España.

INTRODUCTION: Several studies warn that overweight and obesity have become an epidemic with severe consequences in the population's health. The objetive of the present study is to estimate the prevalence of overweight and obesity in Castile and Leon in a sample of children at 6, 11 and 14 years of age, to describe its evolution and its association with life habits and antecedents. MATERIAL AND METHODS: Observational study, retrospective cohort, performed by the pediatricians of the Health Sentinel Network. The study is part of a joint Project with the National Research Center on Human Evolution (CENIEH) in Burgos to know the pattern of growth and development of the child population of Castile and Leon. In 2012, a health examination and a retrospective collection were carried out based on the clinical history of a simple of 326 children, from the cohort was born in 1998. RESULTS: Following the WHO references, at age 14 there was 25.3% of boys and 18.5% of girls with overweight. Obesity was estimated to affect the 8.2% and 4.8% of them respectively. At 11 years of age there was the maximum of overweight in girls and of obesity in boys. At the urban-non urban environment, quantity and quality of sleep and the parents' BMI have been some of the associated factors to weight level of the children. DISCUSSION: In Castile and Leon, as in other populations of our environment, there is a severe problema of overweight and obesity. For their control it is necesary to deepen understanding of lifestyles and antecedents related to the birth as well as to calculate the growth rate in the pediatric age.

Efficacy and safety of eltrombopag in persistent and newly diagnosed ITP in clinical practice.

Eltrombopag is safe and effective in primary chronic ITP. However, lack of clinical trials avoids a clear demonstration of its utility in newly diagnosed and persistent ITP. Our aim here is to report Spanish results for this type of patients. We retrospectively evaluated 220 adult primary ITP patients. According to standard definition, patients were allocated to newly diagnosed (n = 30), persistent (n = 30), and chronic (n = 160) ITP. Groups were homogenous regarding most relevant parameters. 180 (90%) of 220 patients achieved a platelet response (R) with 167 (75.9%) complete responses (CR) after a 15-month follow-up. No statistical significant differences among groups but a trend towards a greater efficacy in newly diagnosed ITP were observed (93.3% of responses with 86.7% of CR). Efficacy in persistent ITP (83.3% of responses with 80.0% of CR) and chronic ITP (79.4% of responses with 73.1% of CR) was similar. 70 patients (31.8%) experienced adverse events. 15 of them were grade 3-4. Most common adverse effects were headache and hepatobiliary laboratory abnormalities (HBLAs). One persistent ITP had a venous thrombosis and one chronic ITP had grade II myelofibrosis. We consider Eltrombopag use for the early stage ITP as effective and safe as it is in chronic ITP.

Diferencias epidemiológicas, quirúrgicas y terapéuticas en reimplantes de miembro superior en pacientes pediátricos / Epidemiological, surgical and therapeutic differences in upper limb replantation in pediatric patients

Introducción y Objetivo. Los reimplantes y revascularizaciones del miembro superior en pacientes pediátricos son procesos infrecuentes. Presentan características diferenciales epidemiológicas, quirúrgicas y terapéuticas que deben ser conocidas por todos los especialistas que se dediquen a su tratamiento para obtener un resultado lo más satisfactorio posible. Presentamos un estudio descriptivo retrospectivo de los casos de reimplantes o revascularizaciones en pacientes en edad pediátrica atendidos en el Servicio de Cirugía Plástica en el Complejo Asistencial de Burgos (Burgos, España). Material y Método. Recogemos los datos de los pacientes con edad inferior o igual a 18 años atendidos durante los años 2001 a 2010. Para la evaluación del éxito vascular y sus diferentes variables añadimos un estudio analítico mediante la aplicación de la prueba exacta de Fisher. Describimos detalladamente las diferencias con los pacientes adultos, tanto en la técnica quirúrgica empleada como en los cuidados y tratamiento postoperatorios; haciendo hincapié en aquellas condiciones que, a nuestro entender, mejoran tanto la calidad asistencial de paciente como el éxito quirúrgico. Resultados. El total de procesos realizados fue de 48 en 40 pacientes diferentes. La tasa de incidencia de datos agregados de estos traumatismos durante el periodo de estudio hallada en nuestra área de referencia estable es de 0.42/100.000 niño-año. Conclusiones. En los reimplantes y revascularizaciones en pacientes pediátricos, dada la mayor frecuencia de traumatismos contusos y las especiales características de los mismos, los resultados vasculares suelen ser peores. Sin embargo, gracias a su enorme plasticidad cerebral y a su gran adaptabilidad, la recuperación funcional y sensitiva será mucho mejor, por lo que la indicación de reimplante/revascularización en estos pacientes es absoluta en todos los casos, y siempre debe ser llevado a cabo por especialistas experimentados y altamente cualificados. El único factor pronóstico del éxito quirúrgico con significación estadística en nuestro grupo de estudio fue el mecanismo lesional (AU)

Background and Objective. Replantation and revascularization of upper limb in pediatric patients are uncommon processes. Also have epidemiological, surgical and therapeutic differential characteristics that should be known by all those specialists engaged in the treatment of this pathology for trying to get an outcome as satisfactory as possible. We present a retrospective study of cases of replantation and revascularization in patients treated by Plastic Surgery Unit in Burgos hospital (Burgos, España). Methods. We review data from all patients with age less or equal to 18 years old during the years 2001-2010. For the evaluation of vascular success and its different variables, an analytical study was added by applying Fisher's exact test. We also describe in detail the differences with adult patients, both the surgical technique and postoperative care and treatment; emphasizing those conditions which we believe improve both the quality of patient care and surgical success. Results. Forty-eight processes from forty different patients were included. The incidence rate of aggregated data from these injuries during the study period, found in our stable reference area is 0.42 / 100.000 child years. Conclusions. Because of the high frequency of contundent traumatisms and the special characteristics of patients, replantation and revascularization of upper limb in pediatric patients usually get worse results. Nevertheless, thanks to their high cerebral plasticity and their high adaptability, functional and sensitive recover use to be complete in all cases; for this reason, indication of replantation and revascularization is mandatory in all the cases, and it must be conducted by experimented and qualified experts. The only prognostic factor for surgical success with statistical signification in our group of patients was injure mechanism (AU)

Prevalencia de sobrepeso y obesidad infantil. Estudio de una cohorte en Castilla y León, España / Prevalence of overweight and obesity in child population. A study of a cohort in Castile and Leon, Spain

Introducción: Varios estudios advierten que el sobrepeso y la obesidad se han convertido en una epidemia con graves consecuencias sobre la salud de la población. El objetivo del presente estudio es estimar la prevalencia de sobrepeso y obesidad en Castilla y León en una muestra de niños a los 6, 11 y 14 años de edad, describir su evolución y su asociación con hábitos de vida y antecedentes. Metodología: Estudio observacional, de cohorte retrospectivo, realizado por los pediatras de la Red Centinela Sanitaria, que se enmarca en un proyecto conjunto con el Centro Nacional de Investigación sobre la Evolución Humana de Burgos para conocer el patrón de crecimiento y desarrollo de la población infantil de Castilla y León. En 2012 se realizó un examen de salud y una recogida retrospectiva a partir de la historia clínica en una muestra de 326 niños, de la cohorte de nacidos en 1998. Resultados: Según los criterios de la OMS, a los 14 años había un 25,3% de sobrepeso entre los niños y un 18,5% entre las niñas. En cuanto a la obesidad, esta afectaba al 8,2 y 4,8%, respectivamente. A los 11 años se produce un pico de sobrepeso en las niñas y de obesidad en los niños. El entorno urbano-no urbano, la calidad y duración del sueño, así como el índice de masa corporal (IMC) de los padres han sido algunos de los factores asociados con el peso de los niños. Discusión: En Castilla y León, como en otras poblaciones de nuestro entorno, existe un grave problema de sobrepeso y obesidad infantil. Para su control, es necesario profundizar sobre los estilos de vida y los antecedentes relacionados con el nacimiento, así como el cálculo de la velocidad de crecimiento en la edad pediátrica

Introduction: Several studies warn that overweight and obesity have become an epidemic with severe consequences in the population's health. The objetive of the present study is to estimate the prevalence of overweight and obesity in Castile and Leon in a sample of children at 6, 11 and 14 years of age, to describe its evolution and its association with life habits and antecedents. Material and methods: Observational study, retrospective cohort, performed by the pediatricians of the Health Sentinel Network. The study is part of a joint Project with the National Research Center on Human Evolution (CENIEH) in Burgos to know the pattern of growth and development of the child population of Castile and Leon. In 2012, a health examination and a retrospective collection were carried out based on the clinical history of a simple of 326 children, from the cohort was born in 1998. Results: Following the WHO references, at age 14 there was 25.3% of boys and 18.5% of girls with overweight. Obesity was estimated to affect the 8.2% and 4.8% of them respectively. At 11 years of age there was the maximum of overweight in girls and of obesity in boys. At the urban-non urban environment, quantity and quality of sleep and the parents' BMI have been some of the associated factors to weight level of the children. Discussion: In Castile and Leon, as in other populations of our environment, there is a severe problema of overweight and obesity. For their control it is necesary to deepen understanding of lifestyles and antecedents related to the birth as well as to calculate the growth rate in the pediatric age