[Imaging studies in the first urinary infection with fever in infants: is voiding cystourethrography necessary?]. / Estudios por imagen en la primera infección urinaria con fiebre del lactante. Es necesaria la cistografía miccional?

INTRODUCTION: The presence of vesicoureteral reflux (VUR) in an infant with urinary tract infection (UTI), does not necessarily lead to an acquired renal injury. Only serious reflux can be a factor in fostering its appearance. OBJECTIVES: To assess whether in infants diagnosed for the first time with a UTI with a fever, a routine initial DMSA can be used as a screening method for detecting severe reflux and replace voiding cystourethrography (VCUG). PATIENTS AND METHODS: We retrospectively studied 162 infants under 2 years old admitted to our hospital due to having a ITU with fever for the first time (92 males and 70 females). In all cases, a renal ultrasound, DMSA and VCUG had been performed a few days after the diagnosis. RESULTS: Of the 162 patients, 62 (38 %) had VUR, of which 56 (90 %) were mild and 6 (10 %) were severe. The DMSA was abnormal in 26/100 patients without VUR (26 %), 12/56 with mild VUR (21 %) and 6/6 of those with severe VUR (100 %). DMSA sensitivity for detecting severe reflux was 100 % and specificity was 76 %. The positive predictive value and negative predictive value was 14 % and 100 % respectively. The positive likelihood ratio was 4.17 and the negative likelihood ratio was 0. CONCLUSIONS: It is unnecessary to carry out VCUG in an infant with an initial UTI, and a negative DMSA.

[Arterial stroke after birth trauma]. / Infarto cerebral arterial tras traumatismo al nacimiento.

Perinatal arterial stroke is a significant cause of neurological deficit, including mental retardation, delayed motor development, epilepsy, and severe cognitive impairment. Most strokes occur in term neonates, due to thromboembolism from an intracranial or extracranial vessel associated with a risk factor such as asphyxia at birth and heart, hematological or infectious diseases. An association with instrumental delivery has not been clearly demonstrated, although several cases have been described in the literature. The incidence of stroke in the perinatal period is estimated to be 1/4000 term neonates per year. We describe three new cases of stroke in term neonates with instrumental delivery and describe the etiopathogenesis, diagnosis and outcome of this entity.

[Current prevalence of asthma in schoolchildren in San Sebastián (Spain)]. / Prevalencia actual de asma en escolares en San Sebastián.

OBJECTIVE: To determine the current prevalence of asthma in children aged 6-12 years old in San Sebastian (Guipuzcoa, Spain). PATIENTS AND METHODS: An observational, cross sectional study was performed in 6-12-year-old children in schools. The International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was employed. Bronchial hyperresponsiveness was investigated using the free running test, with peak expiratory flow (PEF) measured with a peak flow meter as the main measurement. The ISAAC questionnaire (n = 919) was distributed to 460 boys (50.1%) and 459 girls (49.9%) with a mean age of 8 years (SD 1.87). The response rate to the questionnaire was 93 % (n = 855). Participation in the free running test was 90.8% (n = 835). A total of 89.88% of the children (n = 826) completed both tests. RESULTS: The questionnaire of symptoms and signs compatible with asthma revealed a current prevalence of asthma of 25.56% (n = 216) and a cumulative prevalence of 25.44% (n = 85). Nocturnal asthma was found in 29.37% (n = 47) and severe asthma in 9.27% (n = 14). Bronchial hyperresponsiveness was found in 23% of the participants. An epidemiological diagnosis of asthma (asthma-related symptoms plus bronchial hyperresponsiveness) was made in 6.54%. CONCLUSIONS: The current prevalence of asthma in 6-12-year-old schoolchildren in San Sebastian, determined through symptoms and signs compatible with asthma in the previous year and a positive free running test, is similar to that reported in other national studies.

[Erythema nodosum: etiological changes in the last two decades]. / Eritema nudoso: modificación etiológica en las dos últimas décadas.

OBJECTIVE: To study the etiological factors associated with erythema nodosum in children hospitalized between January 1985 and December 2003. MATERIAL AND METHODS: We performed a retrospective, descriptive study through review of the medical records of children with a diagnosis of erythema nodosum (MBDS-ICD 9-CM, code 6952). Forty-five patients (27 boys and 18 girls) aged between 10 months and 14 years were studied. The following variables were analyzed: age, sex, associated symptoms, complementary investigations (blood count, erythrocyte sedimentation rate, throat swab, chest x-ray, Mantoux test, ASLO titer, stool culture, serology) and final diagnosis. RESULTS: The most frequent etiology was tuberculosis (10 patients), followed by Salmonella enteritidis (7 patients), group A beta -hemolytic Streptococcus (3 patients), Salmonella typhimurium (2 patients), Campylobacter jejuni (2 patients), Yersinia enterocolitica (1 patient), infectious mononucleosis caused by Epstein Barr virus (1 patient), cat scratch disease (1 patient), BCG vaccination (1 patient), associated chronic hepatitis B infection (1 patient), and associated amoxicillin treatment (1 patient). Etiology was unknown in 15 patients. The last case of erythema nodosum associated with tuberculous infection dated back to 1991, after which the most frequent etiologic factors associated with erythema nodosum were gastrointestinal pathogens. CONCLUSIONS: According to our results, the main etiological factor currently associated with erythema nodosum is gastrointestinal infection. Consequently, stool cultures, especially when there are associated gastrointestinal symptoms, are essential.

[Transverse myelitis in immunocompetent children]. / Mielitis transversa en inmunocompetentes.

Acute transverse myelitis is an acute inflammatory medullar disease characterized by acute or subacute motor, sensory and autonomic dysfunction. The incidence is low and is estimated at 1-4 cases/10(6) inhabitants per year. In Spain, the disorder is exceptional and most reported cases have occurred in immunodepressed patients. We describe two new cases of transverse myelitis in immunocompetent children and review the etiopathogenesis, diagnosis and outcome of this disorder.

[Domiciliary mechanical ventilation in children: a Spanish multicentre study]. / Ventilación mecánica domiciliaria en niños: estudio multicéntrico español.

INTRODUCTION: Domiciliary mechanical ventilation (DMV) use is increasing in children. Few studies have analysed the characteristics of patients using this technique. MATERIALS AND METHODS: An observational, descriptive, transversal, multicentre study was conducted on patients between 1 month and 16 years of age dependent on domiciliary mechanical ventilation. RESULTS: A total of 163 patients with a median age of 7.6 years from 17 Spanish hospitals were studied. The main reasons for DMV were neuromuscular disorders. The median age at beginning of DMV was 4.6 years. Almost three-quarters (71.3%) received non-invasive ventilation. Patients depending on invasive ventilation were younger, started DMV at an earlier age, and had more hours of mechanical ventilation per day. The large majority (80.9%) used DMV during sleep time only, and 11.7% during the whole day. Only 3.4% of patients had external health assistance. Just under half (48.2%) were being followed up in specific DMV or multidisciplinary clinics. Almost three-quarters (72.1%) of patients attended school (42.3% with adapted schooling). Only 47.8% of school patients had specific caregivers in their schools. CONCLUSIONS: DMV in children is used in a very heterogeneous group of patients, and in an important number of patients it is started before the third year of life. Despite there being a significant proportion of patients with a high dependency on DMV, few families receive specific support at home or at school, and health care surveillance is variable and poorly coordinated.