ABSTRACT
El desarrollo de las subespecialidades pediátricas constituye uno de los hechos más destacados de la pediatría de nuestro país desde mediados del siglo XX. La formación sanitaria especializada (FSE) en pediatría está actualmente basada en la orden SCO/3148/2006, de 20 de septiembre, por la que se aprueba y publica el programa formativo de la especialidad de pediatría y sus áreas específicas. Es un programa formativo estructurado en cuatro años que consigue formar al residente en las competencias necesarias de la pediatría, incluyendo la formación en unas competencias transversales, una formación en pediatría general y debe incluir además la formación en las diferentes áreas específicas. En 1995, el Consejo Nacional de Especialidades Médicas aprueba el concepto de área de capacitación específica (ACE). En Pediatría las ACE son necesarias para garantizar una adecuada asistencia sanitaria a la población infanto-juvenil, al mismo nivel que la medicina del adulto, asegurando mediante una formación reglada, una asistencia de calidad y uniforme. Se trata de dar un reconocimiento oficial a lo que hoy en día es una realidad asistencial en los hospitales españoles, en cualquier Comunidad Autónoma. (AU)
The development of pediatric subspecialties constitutes one of the most outstanding events in pediatrics in our country since the mid-20th century. The specialized health training (SHT) in pediatrics is currently based on order SCO/3148/2006, of September 20, which approves and publishes the training program for the specialty of pediatrics and its specific areas. It is a training program structured in 4 years that manages to train the resident in the necessary skills of pediatrics, including training in transversal skills, training in general pediatrics and must also include training in different specific areas. In 1995 was approved the specific training area (STA). In pediatrics, STAs are necessary to guarantee adequate health care for the child and adolescent population, at the same level as adult medicine, ensuring through regulated training, quality and uniform care. We want to give official recognition to what today is a healthcare reality in all the Spanish hospitals. (AU)
Subject(s)
Humans , Pediatrics/education , Pediatrics/trends , Specialization , 34600 , SpainABSTRACT
The development of pediatric subspecialties constitutes one of the most outstanding events in pediatrics in our country since the mid-20th century. The FSE in pediatrics is currently based on order SCO/3148/2006, of September 20, which approves and publishes the training program for the specialty of pediatrics and its Specific Areas. It is a training program structured in 4 years that manages to train the resident in the necessary skills of pediatrics, including training in transversal skills, training in general pediatrics and must also include training in different specific areas. In 1995 was approved the Specific Training Area (ACE). In pediatrics, ACEs are necessary to guarantee adequate health care for the child and adolescent population, at the same level as adult medicine, ensuring through regulated training, quality and uniform care. We want to give official recognition to what today is a healthcare reality in all the Spanish hospitals.
Subject(s)
Delivery of Health Care , Medicine , Adolescent , Humans , Child , Hospitals , PublishingABSTRACT
Los cuadros clínicos consistentes en fiebre e inflamación sistémica con afectación mucocutánea pueden ser debidos a múltiples etiologías. El pronóstico de estos, en algunas ocasiones, depende del diagnóstico e instauración de tratamiento precoz. Se presenta el caso clínico de un niño atendido en el servicio de urgencias por fiebre, dolor abdominal y cervical. En su caso, los hallazgos de leucocitosis, neutrofilia, elevación de reactantes de fase aguda y transaminasas orientan inicialmente hacia una patología gastrointestinal. Sin embargo, la exploración física continuada junto a un alto índice de sospecha permitió establecer el diagnóstico correcto de enfermedad de Kawasaki mediante ecocardiografía en los primeros cinco días de evolución de la enfermedad. Se trató con gammaglobulina intravenosa, con evolución favorable y resolución completa del cuadro a los cuatro meses del diagnóstico
Clinical pictures consisting of fever and systemic inflammation with mucocutaneous involvement can be caused by multiple aetiologies. Prognosis, in some cases, depends on diagnosis and on early treatment. We present the clinical case of a boy seen in the emergency department with fever, and abdominal and cervical pain. In this case, findings of leucocytosis, neutrophilia, increased acute phase reactants and transaminases initially lead to gastrointestinal disease. However, continued physical examination and high degree of suspicion enabled to make the correct diagnosis of Kawasaki disease using echocardiogram within the first five days of the disease. The treatment was intravenous gamma globulin, with a favourable evolution and complete recovery four months after diagnosis
Subject(s)
Humans , Male , Child, Preschool , Mucocutaneous Lymph Node Syndrome/diagnosis , Echocardiography/methods , gamma-Globulins/administration & dosage , Fever/etiology , Physical Examination/methods , Abdominal Pain/etiology , Neck Pain/etiology , Diagnosis, DifferentialABSTRACT
Introducción. La espasticidad es un problema médico frecuente que impacta de forma significativa en la calidad de vida de los pacientes y sus familias. Objetivo. Analizar y dar respuesta a diferentes cuestiones en el uso de la toxina botulínica tipo A (TBA) en nuestra práctica clínica habitual. Desarrollo. Un grupo de expertos en neurología elaboró una lista de temas relacionados con el uso de la TBA. Se consideraron dos grandes bloques: espasticidad del adulto y del niño con parálisis cerebral. Se realizó una revisión de la bibliografía que incluyó los diferentes artículos publicados en español, inglés y francés hasta junio de 2016. El documento se estructuró como un cuestionario que incluyó las preguntas que, según el criterio del panel, podrían generar mayor controversia o duda. El borrador inicial del documento fue revisado por los miembros del panel y se realizaron las modificaciones necesarias hasta alcanzar el mayor grado de consenso. A continuación, el texto final fue validado. Se incluyeron diferentes preguntas sobre diferentes aspectos de la espasticidad en adultos: evaluación de la espasticidad, técnicas de infiltración, dosis, número de puntos, etc. En cuanto a la espasticidad en los niños con parálisis cerebral, se analizaron preguntas como: edad mínima de infiltración, métodos de sedoanalgesia, etc. Conclusiones. Esta revisión constituye una herramienta para neurólogos, médicos rehabilitadores y residentes de ambas especialidades, dentro de diferentes ámbitos específicos del manejo de la TBA (AU)
Introduction. Spasticity is a medical problem with a high incidence that significantly impact on the quality of life of patients and their families. Aim. To analyze and to answer different questions about the use of botulinum toxin type A (BTA) in our clinical practice. Development: A group of experts in neurology develop a list of topics related with the use of BTA. Two big groups were considered: spasticity in adults and in children with cerebral palsy. A literature search at PubMed for English, French, and Spanish language articles published up to June 2016 was performed. The manuscript was structured as a questionnaire that includes those questions that, according to the panel opinion, could generate more controversy or doubt. The initial draft was reviewed by the expert panel members to allow for modifications, and after subsequent revisions for achieving the highest degree of consensus, the final text was then validated. Different questions about diverse aspects of spasticity in adults, such as methods for evaluating spasticity, infiltration techniques, doses, number of infiltration points, etc. Regarding spasticity in children with cerebral palsy, the document included questions about minimum age of infiltration, methods of analgesia, etc. Conclusions: This review is a tool for continuous training for neurologist and rehabilitation specialist and residents of both specialties, about different specific areas of the management of BTA (AU)
Subject(s)
Humans , Child , Adult , Cerebral Palsy , Botulinum Toxins, Type A/administration & dosage , Muscle Spasticity/drug therapy , Practice Patterns, Physicians' , Muscle Spasticity/classificationABSTRACT
Early-onset hereditary motor and sensory neuropathies are rare diseases representing a broad clinical and genetic spectrum. Without a notable familial history, the clinical diagnosis is complicated because acquired causes of peripheral neuropathy, such as inflammatory neuropathies, neuropathies with toxic causes, and nutritional deficiencies, must be considered. We examined the clinical, electrophysiological, and pathologic manifestations of a boy with an initial diagnosis of chronic inflammatory demyelinating polyneuropathy. The progression of the disease despite treatment led to a suspicion of hereditary motor and sensory neuropathy. Genetic testing revealed the presence of the MPZ p.D90E mutation in heterozygosis. To clarify the pathogenicity of this mutation and achieve a conclusive diagnosis, we investigated the MPZ p.D90E mutation through in silico and cellular approaches. This study broadens the clinical phenotype of hereditary motor and sensory neuropathy due to MPZ mutation and emphasises the difficulty of achieving an accurate genetic diagnosis in a sporadic patient to provide an appropriate pharmacologic treatment.
