Eficacia, tolerancia y seguridad a largo plazo del polietilenglicol 3350 con electrolitos en el tratamiento del estreñimiento funcional en niños / Efficacy, tolerance and safety of polyethylene glycol 3350 plus electrolytes for the treatment of functional constipation in children

OBJETIVO: Evaluar la seguridad renal del tratamiento con polietilenglicol 3350 con electrolitos durante 1, 3 y 6 meses, la tolerancia digestiva y la dosis de eficacia. PACIENTES Y MÉTODOS: Fueron evaluados 3 grupos de 30 pacientes sanos, 2-10 años (media 6,2) con estreñimiento funcional (criterios de Roma III), con 1, 3 y 6 meses de tratamiento. La eficacia fue evaluada por el número de deposiciones/semana y la consistencia de las heces (escala de Bristol). La natriuria y la osmolaridad urinaria se midieron al inicio, 1, 3 y 6 meses. Los principios inmediatos en heces (análisis de reflexión de infrarrojos [FENIR]) y un test de hidrógeno espirado fueron efectuados en el grupo de un mes de tratamiento. RESULTADOS: La dosis efectiva fue de 0,37 g/kg/día (rango 0,18-0,8). El número de deposiciones/semana en la inclusión (2,4 ± 0,64) muestra diferencia significativa (p < 0,001) vs. (6,21 ± 1,5) tras el tratamiento. También se demostró una diferencia significativa en la puntuación en la escala de Bristol (1,9 ± 0,75 vs. 4,9 ± 1,1 [p < 0,001]). La ingesta media de sodio fue de 112 mg (5 mg/kg/día [rango de 4-12 mg/kg/día]). Los valores de sodio y osmolaridad en orina fueron normales en todos los grupos sin diferencia estadística con respecto a controles (90 niños sanos sin tratamiento). Los valores de FENIR fueron normales en todos los pacientes. La prueba de aliento con hidrógeno fue normal, con una media de 7 ppm. CONCLUSIÓN: No se observaron parámetros bioquímicos renales adversos ni alteraciones digestivas. La tolerancia y la eficacia demostraron ser óptimas. El polietilenglicol 3350 con electrolitos puede ser recomendado con seguridad para el tratamiento del estreñimiento funcional en los niños a corto y largo plazo

OBJECTIVE: To assess the renal safety of treatment with polyethylene glycol 3350 with electrolytes at 1, 3 and 6 months, its gastrointestinal tolerance and dose effectiveness. PATIENTS AND METHODS: Three groups of 30 healthy patient aged 2-10 years (mean 6.2 years) who suffered functional constipation (Rome III criteria) with 1, 3 and 6 months of treatment were evaluated. Efficacy was evaluated by the change in the number of stools per week and stool consistency (Bristol scale). Urine screens, sodium and osmolality, were performed at the beginning and after 1, 3 and 6 months of treatment. Stool sample NIRA (near-infrared reflectance analysis) and hydrogen breath test analysis samples were performed on the one-month treatment group. RESULTS: The mean dose was 0.37 g/kg/day (range 0.18 to 0.8) titrated according to age, weigh tand response. The number of stools per week during treatment (2.4±0.64) showed a significant difference (P<0.001) vs (6.21±1.5) after treatment. There was also a significant difference in the Bristol scale score (1.9±0.75 vs 4.9±1.1 [P<0.001]). The mean sodium intake was 112 mg (5 mg/kg/day [range 4-12 mg/kg/day]). The values of sodium and urine osmolality were normal in all groups with no statistical difference compared to normal control values (90 healthy children without treatment). NIRA values were normal in all patients. The hydrogen breath test was normal with a median of 7 ppm. CONCLUSION: There were no adverse renal biochemical parameters or gastrointestinal disorders. Tolerance and efficacy was shown to be optimal. Polyethylene glycol 3350 with electrolytes can be safely recommended for the treatment of functional constipation in children in the short and long term

[Efficacy, tolerance and safety of polyethylene glycol 3350 plus electrolytes for the treatment of functional constipation in children]. / Eficacia, tolerancia y seguridad a largo plazo del polietilenglicol 3350 con electrolitos en el tratamiento del estreñimiento funcional en niños.

OBJECTIVE: To assess the renal safety of treatment with polyethylene glycol 3350 with electrolytes at 1, 3 and 6 months, its gastrointestinal tolerance and dose effectiveness. PATIENTS AND METHODS: Three groups of 30 healthy patient aged 2-10 years (mean 6.2 years) who suffered functional constipation (Rome III criteria) with 1, 3 and 6 months of treatment were evaluated. Efficacy was evaluated by the change in the number of stools per week and stool consistency (Bristol scale). Urine screens, sodium and osmolality, were performed at the beginning and after 1, 3 and 6 months of treatment. Stool sample NIRA (near-infrared reflectance analysis) and hydrogen breath test analysis samples were performed on the one-month treatment group. RESULTS: The mean dose was 0.37g/kg/day (range 0.18 to 0.8) titrated according to age, weight and response. The number of stools per week during treatment (2.4±0.64) showed a significant difference (P<.001) vs (6.21±1.5) after treatment. There was also a significant difference in the Bristol scale score (1.9±0.75 vs 4.9±1.1 [P<.001]). The mean sodium intake was 112mg (5mg/kg/day [range 4-12mg/kg/day]). The values of sodium and urine osmolality were normal in all groups with no statistical difference compared to normal control values (90 healthy children without treatment). NIRA values were normal in all patients. The hydrogen breath test was normal with a median of 7ppm. CONCLUSION: There were no adverse renal biochemical parameters or gastrointestinal disorders. Tolerance and efficacy was shown to be optimal. Polyethylene glycol 3350 with electrolytes can be safely recommended for the treatment of functional constipation in children in the short and long term.

Anticossos monoclonals en la malaltia inflamatòria crònica intestinal / No disponible

No disponible

Deficiencia de zinc sintomática en prematuros alimentados con lactancia materna / Symptomatic zinc deficiency in breast-fed infants

La deficiencia sintomática de zinc en prematuros alimentados con lactancia materna exclusiva es un trastorno adquirido cuyas manifestaciones clínicas pueden ser similares a las de la acrodermatitis enteropática (AE) hereditaria. Los síntomas remiten tras la administración de suplementos orales de zinc. Caso clínico: lactante, varón, de 4 meses de edad, con antecedentes de prematuridad, que fue alimentado durante 8 días con nutrición parenteral en el periodo neonatal y posteriormente con lactancia materna exclusiva. A los 2 meses de vida presentó diarrea persistente, vómitos y lesiones cutáneas eczematosas, de predominio acro y periorificial. Los exámenes complementarios revelaron bajos niveles de zinc en el suero del lactante (3µmol/l) y en leche materna (8µmol/l), con niveles normales de zinc en suero materno (17µmol/l). Se efectuó tratamiento con sulfato de zinc oral (2mg/Kg), remitiendo los síntomas sin recidivas posteriores. Conclusión: El reconocimiento de la deficiencia sintomática de zinc en prematuros hijos de madre con leche deficitaria en zinc es importante, ya que el tratamiento es eficaz y definitivo. La nutrición parenteral sin suplementos de zinc puede agravar el déficit. En los lactantes de riesgo es recomendable determinar niveles séricos de zinc

Symptomatic zinc deficiency in breast-fed infants is a severe disorder, caused by a low level of zinc in mother’s milk. Premature infants are more vulnerable to develop zinc deficiency than full-term infants. The clinical symptoms resemble those of hereditary acrodermatitis enterophatica (AE). In acquired zinc deficiencies the disorder is transient and patients respond well to oral zinc supplements. Clinical case: A 4 month-old exclusively breast-fed premature infant presented with persistent diarrhea, vomiting and eczematoid skin lesions, with acral and peri-orificial dermatitis resembling AE. The symptoms began at 2 months of age. She received parenteral nutrition for the first eight days followed by mother’s milk exclusively. Laboratory investigations revealed lowered zinc levels in the infant’s serum (3µmol/l) and in her mother’s milk (8µmol/l), with normal level of zinc in the mother’s serum (17µmol/l). Healing was rapid after oral zinc supplementation (zinc sulphate 2mg/Kg), with complete remission of the symptoms. Conclusions: Recognition of zinc deficiency in premature newborns to mothers who seem to secrete milk that is zinc- deficiency is essential because its treatment is effective. This may lead to severe symptomatic zinc deficiency in premature infants, requiring treatment with oral zinc supplement. Parenteral nutrition without zinc supplements may be a contributory factor to zinc deficiency in preterm infants. Serum zinc levels should be checked in at-risk babies

[Slipping rib syndrome as a cause of recurrent abdominal pain in children]. / Síndrome de la costilla deslizante como causa de dolor abdominal recidivante en la edad pediátrica.

The slipping rib syndrome can be produced by a direct or indirect traumatism over the sternal tip of the costal cartilages 8, 9 and 10. The main complains are abdominal pain in the right or left upper abdominal, quadrants, and sometimes a sensation of rubbing or slipping of the ribs. The hoocking maneuver is useful in the diagnosis of this syndrome. Three clinical cases of the slipping rib syndrome are reported. This syndrome must be taken into account is the differential diagnosis of the abdominal pain in pediatric patients.