Enuresis infantil, formar y educar / Children enuresis: training and educating

Introducción: La enuresis se define como la eliminación nocturna, involuntaria y funcionalmente normal de orina que ocurre a una edad en la que cabe esperarse en el niño un control voluntario de la micción. Es un motivo frecuente de consulta en pediatría, posiblemente, infradiagnosticado y, por lo tanto, infratratado que puede llegar a ser un problema de salud importante en niños y adolescentes. Objetivo: Examinar y analizar datos epidemiológicos sobre enuresis en una muestra de población infantil e importancia de su diagnóstico tempano. Métodos: estudio transversal, descriptivo a través de encuestas rellenadas en un período de 6 meses, por pacientes de edad pediátrica de 5-15 años de edad, en consultas externas del Hospital Lluís Alcanyís de Xàtiva (Valencia) Resultados: 321 pacientes incluidos, 50,5 por ciento mujeres. Rango de edad de los incluidos entre 5-15 años, con media de 11 años. 2,8 por ciento incontinencia diurna, 8,4 por ciento enuresis nocturna, de los que el 77,8 por ciento fueron enuresis monosintomática primaria, 77,8 por ciento de los participantes habían comunicado a su pediatra su situación de salud y 22,2 por ciento, no lo notificaron. Conclusiones: Es importante diagnosticar a tiempo la enuresis, educar a las familias en los conocimientos de este problema y ayudar a dar soluciones y un tratamiento adecuado e individualizado. Un alto porcentaje no despreciable, no informa a su pediatra, actitud que puede retrasar su tratamiento. El diagnóstico precoz y atención de este problema de salud, pueden ayudar a los niños a mejorar su calidad de vida(AU)

Introduction: Enuresis is defined as the nighttime, involuntary and functionally normal removal of urine that occurs at an age at which voluntary urination control can be expected in the child. It is a common cause of consultation in pediatrics, possibly rarely diagnosed and treated, which can become a major health problem in children and adolescents. Objective: Examine epidemiological data on enuresis in a sample of children population and the importance of its early diagnosis. Methods: Cross-sectional study, descriptive through surveys filled in over a period of 6 months, by pediatric patients aged 5-15 years, in external consultations of Lluís Alcanyís de Xativa Hospital (Valencia) Results: 321 patients included in the study, 50.5 percent female ones. The age range of those included was of 5 to 15 years, with an average of 11 years. There was 2.8 percent of daytime incontinence, 8.4 percent of nocturnal enuresis, of which 77.8 percent were primary monosymptomatic enuresis; 77.8 percent of participants had reported their health status to their pediatrician and 22.2 percent did not report it. Conclusions: It is important to diagnose enuresis early, educate families in their knowledge of this problem, and help providing adequate and individualized solutions and treatment. A high and not negligible percentage of families does not inform their pediatrician, and this attitude can delay the treatment. Early diagnosis and care of this health problem can help children improve their quality of life(AU)

Tuberculosis por Mycobacterium africanum multirresistente: Caso clinico pediatrico / Tuberculosis by multiresistant Mycobacterium africanum: Pediatric clinical case

La tuberculosis, considerada desde 2003 por la Organización Mundial de la Salud una emergencia global de salud, provoca una mortalidad anual de alrededor de 2 millones de personas, fundamentalmente, en países en vías de desarrollo. En la población pediátrica española, la incidencia es de 5 casos/100 000 niños de entre 5 y 14 años y 13 casos/100 000 niños de entre 0 y 4 años. La infección se transmite por vía respiratoria por enfermos bacilíferos. Los niños eliminan escasos bacilos en secreciones respiratorias y no suelen transmitir la infección. En España, el porcentaje de resistencias a isoniazida en la población general es de 5% y es superior en la población inmigrante, lo cual es importante tener en cuenta para el tratamiento de los casos. Se presenta un caso de tuberculosis por Mycobacterium africanum multirresistente al tratamiento, con evolución satisfactoria posterior a la terapia múltiple.

Tuberculosis, considered since 2003 by the World Health Organization a global health emergency, causes annual mortality of approximately 2 million people, mainly in developing countries. In the Spanish pediatric population, the incidence is 5 cases/100 000 children between 5 and 14 years and 13 cases/100 000 children between 0 and 4 years. The infection is transmitted through the respiratory tract by baciliferous patients. Children eliminate few bacilli in respiratory secretions and do not usually transmit the infection. In Spain, the resistance to isoniazid in the general population is 5%, being higher in the immigrant population, which is important to take into account for the treatment of cases. A case of tuberculosis due to Mycobacterium africanum multiresistant to treatment is presented, with satisfactory evolution after multiple therapy.

Resultados da abordagem transeptal para a valva mitral com coração batendo / Results of beating heart mitral valve surgery via the trans-septal approach

OBJETIVO: A cirurgia da valva mitral pode ser feita via transatrial ou transeptal. Embora a transatrial seja a preferida, a via transeptal tem sido utilizada mais recentemente e tido um grande valor nas operações com o coração batendo. Mostramos a nossa experiência na cirurgia da valva mitral via transeptal com coração batendo e discutimos seus benefícios e problemas. MÉTODOS: Entre 2000 e 2007, 214 pacientes consecutivos foram operados com o coração batendo. A operação foi feita por via transeptal sem pinçamento da aorta, com o coração batendo e eletrocardiograma normal e em ritmo sinusal. RESULTADOS: A idade média foi de 56,03 ± 13,93 anos (intervalo: 19-86 anos; mediana: 56 anos). Havia 131 (61,2 por cento) pacientes do sexo masculino e 83 (38,8 por cento), do feminino. Foram utilizadas 108 (50,5 por cento) próteses biológicas e 39 (18,2 por cento) mecânicas. Reparo da valva foi feito em 67 (31,3 por cento) pacientes. A estadia hospitalar foi de 17,4 ± 20,0 dias (intervalo: 3-135 dias; mediana: 11 dias). Balão intra-aórtico foi utilizado em 12 (5,6 por cento) pacientes. A mortalidade hospitalar foi de 7,4 por cento. Reoperação para revisão de hemostasia foi necessária em 15 pacientes. CONCLUSÃO: A operação com o coração batendo é uma opção para proteção miocárdica em pacientes submetidos a cirurgia da valva mitral. A técnica é facilitada ao se usar a via transeptal, reduzindo a insuficiência aórtica e melhorando a visualização do aparato mitral.

OBJECTIVE: Mitral valve surgery can be performed through the trans-atrial or the trans-septal approach. Although the trans-atrial is the preferred method, the trans-septal approach has also been used recently and has a particular value in beating-heart mitral valve surgery. Herein we report our experience with beating-heart mitral valve surgery via trans-septal approach, and discuss its advantages and pitfalls. METHODS: Between 2000 and 2007, 214 consecutive patients were operated upon utilizing beating heart technique for mitral valve surgery. The operation was performed via transseptal approach with the aorta unclamped, the heart beating, with normal electrocardiogram and in sinus rhythm. RESULTS: Mean age was 56.03 ± 13.93 years (range: 19-86 years; median: 56 years). There were 131 (61.2 percent) males and 83 (38.8 percent) females. Of the prostheses used, 108 (50.5 percent) were biological, and 39 (18.2 percent) were mechanical. Mitral repairs were performed in 67 (31.3 percent) patients. Mean hospital stay was 17.4 ± 20.0 days (range: 3-135 days; median: 11 days). Intra-aortic balloon pump (IABP) utilization was required in 12 (5.6 percent) of 214 patients. One-month mortality was 7.4 percent, and re-operation for bleeding was needed in 15 (7 percent) patients. CONCLUSIONS: Beating-heart mitral valve surgery is an option for myocardial protection in patients undergoing mitral valve surgery. This technique is facilitated by the trans-septal approach due to reduced aortic insufficiency and improved visualization of the mitral apparatus.