[Is the incidence of parapneumonic pleural effusion increasing?]. / Está aumentando la incidencia de derrames pleurales paraneumónicos?

INTRODUCTION: Streptococcus pneumoniae is the microorganism most frequently associated with complicated pleural effusion. After the introduction of the heptavalent pneumococcal vaccine, there was a decline in the incidence of invasive pneumococcal disease and, to a lesser extent, in that of pneumonia. However, the incidence of empyema apparently increased. The antipneumococcal heptavalent vaccine was introduced in Spain in 2001. OBJECTIVES: To determine whether the incidence of pleural effusion secondary to pneumonia has increased in hospitalized patients and to examine the possible influence of the antipneumococcal heptavalent vaccine on the incidence rate of parapneumonic effusions. PATIENTS AND METHODS: Patients aged less than 16 years old admitted to our hospital with a diagnosis of pneumonia between 1999 and 2005 were retrospectively reviewed. We calculated the annual incidence rate of pleural effusion with respect to the total number of patients admitted with pneumonia and with respect to patients considered to have probable bacterial pneumonia, based on previously established criteria. RESULTS: A total of 337 patients were analyzed, of which 213 (63.2%) met the criteria for a diagnosis of probable bacterial pneumonia. Pleural effusion was found in 34 patients (15.9%), and 13 of these effusions (38%) were complicated. No clear trend was detected in the annual incidence of probable bacterial pneumonia per 100 admitted patients, although the highest numbers were detected in the last two years of the study period. The percentage of complications (effusions) remained constant (mean: 16.28%). No differences were found in the effusion rate between vaccinated and unvaccinated patients (12.5% vs 18.6%). CONCLUSIONS: The trend in the incidence of parapneumonic pleural effusions was parallel and proportional to that of probable bacterial pneumonia.

[Viral respiratory tract infections in the first six months of life]. / Infecciones virales de vías respiratorias en los primeros seis meses de vida.

BACKGROUND: Respiratory syncytial virus and Influenza virus infections are known causes of hospital admission in infants. It is less well known the pattern of virus infections in infants under 6 months of age in the outpatient setting. OBJECTIVE: To describe the clinical and epidemiological pattern of community-acquired viral respiratory infections in infants under 6 months. PATIENTS AND METHODS: A cohort of infants from the 8 and 9 Madrid Health Districts was followed by telephone calls every two weeks since birth during the epidemic winter season. Clinical and epidemiological data were collected in pre-designed questionnaires. Nasopharyngeal aspirate was obtained in every patient with symptoms compatible with respiratory infection. Diagnosis of the more common virus was made with direct immunofluorescence and nucleic acid amplification test (PCR). RESULTS: Were recruited 316 newborns. The 1,865 phone calls made (median 4 for every child), produced 106 visits, and the illness confirmed in 89 illness. Rhinitis (91%) and cough (69%) were the most common symptoms. Upper respiratory infection was the principal clinical diagnosis (84.5%), and 17 of the 72 samples (23.2%) were positive. Most common viruses were RSV (41.1%) and rhinovirus (35.2%). Of the children visited, 17 out of 106 (16%) (5.3% of the cohort) were admitted to hospital. Diagnoses were febrile syndrome and bronchiolitis. We did not find any epidemiological factor associated with viral respiratory infection in positive cases. CONCLUSIONS: In our population most of the respiratory infections in infants are minor and do not need hospital assistance. Rhinovirus and RSV are the major pathogens. We did not find any epidemiological factor associated with viral respiratory infection.

Genetic testing among Spanish pediatric neurologists: Knowledge, attitudes and practices.

Advances in genetic testing applied to child neurology have enabled the development of genetic tests with greater sensitivity in elucidating an etiologic diagnosis for common neurological conditions. The objective of the current study was to examine child neurologists' perspectives and insights into genetic testing. We surveyed 118 Spanish child neurologists, exploring their knowledge, attitudes, and practices concerning genetic tests. All of them had requested at least one genetic test in the past six months. Global developmental delay or intellectual disability in absence of a strong specific etiologic suspicion and autism spectrum disorders were the disorders for which genetic testing was most frequently requested. The most commonly requested genetic test was CGH-array. Overall, child neurologist perception of readiness for making genetic-related decisions was not bad, although many would like to have a greater support from geneticists and were interested in increasing the time dedicated to genetics within their continuing education program. These data have important implications for future practice, research, and education.

[Acute myocardial infarction in a 5-year-old boy]. / Infarto agudo de miocardio en un niño de cinco años.

We present the case of a child five and half years-old that died suddenly due to an acute myocardial infarction. The anatomopathological study showed a total obstruction of the left coronary ostium by mixoide dysplasia of the aortic valve. We revise the literature and briefly expose the more frequent causes of infarction in infancy.

[Metabolic alterations related to syndrome X and low vitamin E levels in obese children with acanthosis nigricans]. / Alteraciones relacionadas con el síndrome X y bajos niveles de vitamina E en niños con obesidad y acantosis nigricans.

BACKGROUND: In adults, both metabolic alterations related to syndrome X and lower plasma vitamin E levels have been associated with an increased risk of developing cardiovascular disease. OBJECTIVES: To study the presence of metabolic alterations related to syndrome X and to determine the plasma levels of vitamin E in obese children with acanthosis nigricans. METHODS: We performed a prospective study in 42 obese children [15 with acanthosis nigricans (AN) and 27 without]. Thirteen healthy non-obese children were also studied. After a 12-hour fast, plasma levels of glucose, insulin, triglycerides, cholesterol, high-density lipoprotein (HDL)-cholesterol, and vitamin E were determined. The insulin resistance index was also calculated. Differences between groups were determined using ANOVA. RESULTS: Obese children with AN showed higher plasma levels of insulin and triglycerides and lower plasma levels of HDL-cholesterol and vitamin E, as well as a higher insulin resistance index than non-obese children and obese children without AN. CONCLUSIONS: In obese children, the presence of acanthosis nigricans is linked to a group of metabolic alterations associated with a higher risk of developing cardiovascular disease and type 2 diabetes.

Tos ferina: revisión clínica a propósito de un caso / Whooping cough: a case report and clinical review

La tos ferina es una enfermedad contagiosa que afecta en la actualidad a lactantes menores de seis meses y a adolescentes o adultos jóvenes, debido a una inmunidad vacunal limitada. Cursa clínicamente en varias fases, siendo el periodo de contagio la fase catarral inicial y las dos primeras semanas de la fase paroxística. En los lactantes pequeños puede presentarse de forma atípica, con pausas de apnea sin tos llegando a ser un cuadro potencialmente grave, por lo que pueden requerir ingreso. El diagnóstico es clínico, dadas las dificultades técnicas para la confirmación microbiológica. El germen responsable es Bordetella pertussis, aunque existen cuadros clínicos similares producidos por otros microorganismos, tanto virus como bacterias. El tratamiento antibiótico recomendado es con azitromicina tanto para el caso como para los contactos. No se ha demostrado que los tratamientos adyuvantes sean útiles(AU)

Whooping cough is an infectious disease that affects currently to infants less than six months old and teenagers or young adults, due to a limited vaccine efficacy. The clinical course has several phases, being the period of infection the initial catarrhal stage and the first two weeks of the paroxysmal phase. Young infants can have an atypical presentation with apnoea pauses without cough, becoming a potentially serious disease that may require admission. The diagnosis is clinical due to the technical difficulties in the laboratory confirmation. The responsible organism is Bordetella pertussis, although similar clinical symptoms can be produced by other micro-organisms, both viruses and bacteria. The recommended antibiotic is azithromycin for both the case and contacts. Complementary treatments have not proven useful(AU)

Lactancia materna y protección contra las infecciones respiratorias en los primeros meses de vida / Breastfeeding and the protection against respiratory infections in the first months of life

Introducción: entre las ventajas de la lactancia materna (LM) se incluye su papel protector ante infecciones respiratorias (IR). Objetivos: describir el patrón de LM de una cohorte de recién nacidos (RN) y su protección contra las IR en el lactante. Material y métodos: estudio prospectivo de 316 RN, de las áreas 8 y 9 de Madrid, desde el nacimiento mediante llamadas telefónicas quincenales durante el invierno, registrando datos clínicos y epidemiológicos. Si presentaban sintomatología compatible con IR se recogió aspirado nasofaríngeo. Resultados: mil ochocientas sesenta y cinco llamadas (mediana: 4,2 [1-11]) y 106 visitas programadas. Al mes, el 56,1% recibía LM exclusiva; a los tres meses, el 39,4%, y a los cinco meses, el 31,9%. La LM exclusiva se mantuvo 65,1 días (desviación estándar: 43,49) y ningún factor se asoció a una mayor duración. Hubo 89 episodios de IR aguda. Los hermanos escolares multiplican por 1,74 (intervalo de confianza del 95% [IC 95%]: 1,12-2,72) el riesgo de IR en todos los estratos de duración de LM exclusiva. El riesgo de infección se multiplica por cinco (IC 95%: 2,07-12,19) si la LM exclusiva dura menos de un mes, por 9,8 (IC 95%: 4,06-23,66) si dura entre 30 y 60 días y por 3,4 (IC 95%: 1,28-9,19) si dura entre 60 y 90 días. Conclusiones: aunque muchos RN inician LM exclusiva, solo la tercera parte la mantiene a los cinco meses. Ningún factor se asoció a mayor duración de la misma. La LM es un factor protector de IR cuando dura más de 90 días. Se debe fomentar el mantenimiento de la LM más allá del tercer mes, especialmente en aquellos con hermanos escolares (AU)

Background: the protective role against respiratory infections is included among the advantages of breastfeeding (BF). Objective: to describe the pattern of BF in a cohort of newborns and its protective role against respiratory infections (RI) in the infant. Material and methods: a cohort of 316 newborns (NB) from Madrid Health Districts 8 and 9 was followed by telephone calls every fortnight during the winter season recording clinical and epidemiological data. Nasopharyngeal aspirate was obtained in every patient with symptoms compatible with RI. Results: one thousand, eight hundred and sixty-five phone calls [median: 4.2 (1-11)], and 106 scheduled visits were conducted. At the age of 1 month 56.1% of the infants were exclusively breastfed, at 3 months 39.4% and at 5 months 31.9%. The duration of BF was 65.1 days (SD: 43.49) and no factors were associated to a longer duration. Eighty nine acute RI were registered. The presence of siblings in school age increased the risk of RI by 1.74 (CI 95%: 1.12-2.72) in all the strata of duration of exclusive BF. The risk of RI increased by 5 (CI 95%: 2.07-12.19) if breastfeeding lasted less than 1 month, by 9,8 (CI 95%: 4,06-23,66) between 30-60 days and by 3,4 (CI 95%: 1.28-9,19) if it lasted 60-90 days. Conclusions: though many NB begin BF, only a third part of them go on with it at the age of 5 months. No covariant was associated with a longer duration. BF is a protector factor against RI when it lasts more than 90 days. So it must be promoted specially in those infants with siblings in school age (AU)

[Chronic recurrent parotitis in children. Apropos of 25 cases]. / Parotiditis crónica recidivante en niños (PCR). A propósito de 25 casos.

The clinical, analytical and radiological findings of 25 cases of recurrent parotitis aging 2 to 12 years are reviewed. The greater incidence in males, the preferentially unilateral localization and the absence of an associated pathology or immunological defect is pointed out, considering the chronic recurrent parotitis and independent pathology. The value of sialography as a diagnostic method is confirmed, finding alterations in 90% of cases. The alterations of the acinar system represented as sialectasias were the most commonly found (86.9%), following in order of frequency the alterations of the ductal system (70%). Spontaneous recuperation with less frequent episodes in adolescence is common, and complications are rare, so that we consider symptomatic treatment appropriate, reserving surgical treatment for complicated cases.

¿Está aumentando la incidencia de derrames pleurales paraneumónicos? / Is the incidence of parapneumonic pleural effusion increasing?

Introducción: Streptococcus pneumoniae es el agente etiológico aislado con más frecuencia en los derrames paraneumónicos complicados. Desde la introducción de la vacuna antineumocócica heptavalente (VCN-7), ha disminuido la enfermedad neumocócica invasiva y, en menor grado, la incidencia de neumonías, pero con un aparente aumento del empiema. En España la vacuna fue comercializada en 2001. Objetivos: Determinar si existe un aumento de la incidencia de derrames pleurales en los pacientes ingresados por neumonía y la posible influencia de la vacunación con VCN-7 sobre la incidencia de dichos derrames. Pacientes y métodos: Estudio retrospectivo de los pacientes menores de 16 años ingresados en nuestro hospital por neumonía entre 1999 y 2005. Se calculó la incidencia anual de derrames pleurales respecto al número total de neumonías ingresadas y respecto a las consideradas como de probable origen bacteriano (NPOB) según criterios establecidos. Resultados: Se analizaron 337 pacientes. De éstos, 213 cumplían criterios de NPOB (63,2 %). Un total de 34 pacientes presentaron derrame pleural (15,9 %), 13 de los cuales (38 %) fueron complicados. No se pudo objetivar en el período estudiado una tendencia clara en la incidencia anual de NPOB por 100 pacientes ingresados, aunque en los dos últimos años se detectaron las cifras más altas. La proporción de complicaciones (derrames) se mantuvo constante (media 16,28 %). No existieron diferencias en la aparición de derrames entre los pacientes vacunados con VCN-7 y los no vacunados (12,5 % frente a 18,6 %). Conclusiones: Se objetiva una evolución de la incidencia de derrames pleurales paraneumónicos paralela y proporcional a la de las neumonías bacterianas (AU)

Introduction: Streptococcus pneumoniae is the microorganism most frequently associated with complicated pleural effusion. After the introduction of the heptavalent pneumococcal vaccine, there was a decline in the incidence of invasive pneumococcal disease and, to a lesser extent, in that of pneumonia. However, the incidence of empyema apparently increased. The antipneumococcal heptavalent vaccine was introduced in Spain in 2001. Objectives: To determine whether the incidence of pleural effusion secondary to pneumonia has increased in hospitalized patients and to examine the possible influence of the antipneumococcal heptavalent vaccine on the incidence rate of parapneumonic effusions. Patients and methods: Patients aged less than 16 years old admitted to our hospital with a diagnosis of pneumonia between 1999 and 2005 were retrospectively reviewed. We calculated the annual incidence rate of pleural effusion with respect to the total number of patients admitted with pneumonia and with respect to patients considered to have probable bacterial pneumonia, based on previously established criteria. Results: A total of 337 patients were analyzed, of which 213 (63.2 %) met the criteria for a diagnosis of probable bacterial pneumonia. Pleural effusion was found in 34 patients (15.9 %), and 13 of these effusions (38 %) were complicated. No clear trend was detected in the annual incidence of probable bacterial pneumonia per 100 admitted patients, although the highest numbers were detected in the last two years of the study period. The percentage of complications (effusions) remained constant (mean: 16.28 %). No differences were found in the effusion rate between vaccinated and unvaccinated patients (12.5 % vs 18.6 %). Conclusions: The trend in the incidence of parapneumonic pleural effusions was parallel and proportional to that of probable bacterial pneumonia (AU)

Infecciones virales de vías respiratorias en los primeros seis meses de vida / Viral respiratory tract infections in the first six months of life

Antecedentes: El virus respiratorio sincitial (VRS) y otros virus son causas conocidas de hospitalización en lactantes. Menos conocido es el patrón de virus en infecciones extrahospitalarias en menores de 6 meses. Objetivo: El objetivo de este estudio es describir las características clínicas y los factores epidemiológicos asociados con las infecciones respiratorias virales de ámbito extrahospitalario en menores de 6 meses. Pacientes y métodos: Estudio prospectivo en cohorte de niños de las áreas 8 y 9 de Madrid controlados desde el nacimiento mediante llamadas telefónicas quincenales durante una temporada invernal. Se registraron datos clínicos y epidemiológicos en cuestionarios prediseñados. Se exploró y recogió el aspirado nasofaríngeo (ANF) cuando el paciente presentó sintomatología compatible con una infección respiratoria. El diagnóstico de los virus más comunes se realizó con inmunofluorescencia directa (IFD) y amplificación genómica (PCR). Resultados: Fueron seleccionados 316 recién nacidos. Se realizaron 1.865 llamadas telefónicas (mediana 4), y 106 visitas, en 89 de las cuales se confirmó la enfermedad. Los síntomas más frecuentes fueron rinitis (91 %) y tos (69 %). El diagnóstico clínico principal fue infección respiratoria de vías altas (82 %); 17 de 72 ANF realizados (23,2 %) fueron positivos. Se detectaron rinovirus (41,1 %) y VRS (35,2 %). Ingresaron un 16 % (17/106) de los niños atendidos por enfermedad (el 5,3 % de la cohorte), diagnosticados de síndrome febril y de bronquiolitis. No encontramos ningún factor epidemiológico asociado con la infección respiratoria viral en los casos positivos. Conclusiones: En nuestro medio las infecciones respiratorias de los lactantes son en su mayoría banales y no precisan atención hospitalaria. El rinovirus y el VRS son los principales agentes etiológicos. No se encontraron factores epidemiológicos relacionados con la infección respiratoria asociada a virus (AU)

Background: Respiratory syncytial virus and Influenza virus infections are known causes of hospital admission in infants. It is less well known the pattern of virus infections in infants under 6 months of age in the outpatient setting. Objective: To describe the clinical and epidemiological pattern of community-acquired viral respiratory infections in infants under 6 months. Patients and methods: A cohort of infants from the 8 and 9 Madrid Health Districts was followed by telephone calls every two weeks since birth during the epidemic winter season. Clinical and epidemiological data were collected in pre-designed questionnaires. Nasopharyngeal aspirate was obtained in every patient with symptoms compatible with respiratory infection. Diagnosis of the more common virus was made with direct immunofluorescence and nucleic acid amplification test (PCR). Results: Were recruited 316 newborns. The 1,865 phone calls made (median 4 for every child), produced 106 visits, and the illness confirmed in 89 illness. Rhinitis (91 %) and cough (69 %) were the most common symptoms. Upper respiratory infection was the principal clinical diagnosis (84.5 %), and 17 of the 72 samples (23.2 %) were positive. Most common viruses were RSV (41.1 %) and rhinovirus (35.2 %). Of the children visited, 17 out of 106 (16 %) (5.3 % of the cohort) were admitted to hospital. Diagnoses were febrile syndrome and bronchiolitis. We did not find any epidemiological factor associated with viral respiratory infection in positive cases. Conclusions: In our population most of the respiratory infections in infants are minor and do not need hospital assistance. Rhinovirus and RSV are the major pathogens. We did not find any epidemiological factor associated with viral respiratory infection (AU)

Síndrome de esplenomegalia tropical en el diagnóstico diferencial de esplenomegalia masiva / Tropical splenomegaly syndrome in the differential diagnosis of massive splenomegaly

Presentamos el caso de un niño de 11 años de edad, de origen guineano, enviado a nuestro hospital por presentar esplenomegalia masiva, anemia, eosinofilia y fiebre intermitente. El estudio etiológico inicial no fue concluyente. Finalmente, se estableció el diagnóstico de síndrome de esplenomegalia por hiperreactividad a la malaria, o síndrome de esplenomegalia tropical, para lo cual fueron esenciales la exclusión de otras causas y la respuesta al tratamiento antipalúdico; la biopsia hepática fue característica del cuadro

We report the case of an 11-year-old boy from Equatorial Guinea, referred to our hospital with massive splenomegaly, anemia, eosinophilia and intermittent fever. The preliminary etiological study was not conclusive. Finally, a diagnosis of splenomegaly syndrome due to hyperreactivity to malaria or “tropical splenomegaly syndrome” was established. The exclusion of other causes and the response to antimalarial treatment provided the key to the diagnosis, and liver biopsy revealed the pattern typically associated with this condition

Alteraciones relacionadas con el síndrome X y bajos niveles de vitamina E en niños con obesidad y acantosis nigricans / Metabolic alterations related to syndrome X and low vitamin E levels in obese children with acanthosis nigricans

Antecedentes: En adultos, tanto las alteraciones metabólicas asociadas al síndrome X, como la disminución en las concentraciones plasmáticas de vitamina E, se han asociado a un mayor riesgo de desarrollar enfermedades cardiovasculares. Objetivos: Estudiar en niños obesos con acantosis nigricans la presencia de alteraciones metabólicas relacionadas con el síndrome X y determinar las concentraciones plasmáticas de vitamina E. Métodos: Se llevó a cabo un estudio prospectivo en 42 niños obesos, 15 con acantosis nigricans (OB+AN) y 27 sin ella (OB-AN), y 13 niños sanos sin obesidad. En todos ellos, y tras 12 h de ayuno, se determinaron las concentraciones plasmáticas de glucosa, insulina, vitamina E, triglicéridos, colesterol y colesterol HDL. Se calculó el índice de resistencia a la insulina. Las diferencias entre grupos se determinaron mediante el análisis de la varianza. Resultados: Los niños obesos con acantosis nigricans presentaron mayores concentraciones de insulina plasmática y de triglicéridos, menores niveles de colesterol HDL (lipoproteínas de alta densidad) y de vitamina E en plasma, así como un índice de resistencia a la insulina más elevado que los niños obesos sin acantosis nigricans o que los valores observados en un grupo de niños sin obesidad. Conclusiones: La presencia de acantosis nigricans en niños obesos define a un grupo de niños con alteraciones metabólicas asociadas a un mayor riesgo de desarrollar enfermedades cardiovasculares y diabetes de tipo 2 (AU)