[Descriptive study of malaria cases in a general hospital in Madrid between 1996 and 2011]. / Estudio descriptivo de los casos de paludismo en la población pediátrica en un hospital general de Madrid entre 1996 y 2011.

INTRODUCTION: Malaria causes around 863,000 deaths per year, mostly of them in children under 5 years old. MATERIAL AND METHODS: We have reviewed the epidemiological data of malaria cases in a pediatric department in a Hospital in the Community of Madrid, in the period 1996-2011. RESULTS: In the period reviewed, 103 cases of malaria were diagnosed in children under 14 years old. Sixty percent were males and the average age was 4.5 years. In most cases, the infection arose during a visit to relatives in the country of origin. The vast majority did not have malaria prophylaxis. Twenty-five percent of the cases were diagnosed as complicated malaria, the main criteria being hyperparasitemia, of which 80% of the patients did not present any other complications CONCLUSIONS: A high level of suspicion must be maintained in any patient who comes from a malaria endemic area. The key factor responsible for the infection was the lack of chemoprophylaxis.

A retrospective study of allergic diseases in children with food hypersensitivity

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[Special needs of schoolchildren with diabetes mellitus. Point of view of parents and teachers]. / Necesidades del niño escolarizado con diabetes mellitus. Visión de padres y profesores.

BACKGROUND: The daily care of a diabetic (IDDM) child is essential for the short and long term evolution of the disease, and must include the hours the child spends in school. The presence of Trained personnel are needed who will be able to intervene in time if a serious complication, such as hypoglycemia, occurs. Their presence can help to ensure correct control of the disease and avoid long term complications. OBJECTIVES: To understand of the day to day life of children with IDDM, focusing on their school hours. To understand the attitude of primary and secondary school teachers towards pupils with IDDM. PATIENTS AND METHODOLOGY: Descriptive and transversal study on IDDM patients between the ages of 3 and 18, treated within the Healthcare Area number 3 in the Madrid Region, and their teachers. Two different kinds of surveys were distributed: the 1st survey by Fundación para la Diabetes (Foundation for Diabetes) contained 80 questions aimed at patients between the ages of 3 and 18 and their parents. Questions were related to patient's daily life and school environment. The 2nd survey, which allowed free response, was aimed at primary and secondary school teachers about their own experiences working as professionals with pupils with IDDM. RESULTS: Fifty questionnaires addressed to parents and patients were valid in our remit, and we emphasize the following: the ages of major participation were 10 to 14 years; 86% of children knew how to measure blood glucose and 66% how to administer insulin; 74% had no problems with school integration, however, up to 50% of children under 6 years had suffered a problem occasionally; on the 50% of the occasions when a patient needed insulin administration during school hours, it was done by a relative; 66% of hypoglycaemias were resolved by the patient. Health personnel is present only in 8% of the schools studied; 98% of those surveyed think teachers should have written instructions on the signs and symptoms and action to be taken if a hypoglycemia occurs. Questionnaires for teachers were answered by 54% of them (76 of a total of 140), we would like to point out the following: 71% of them recognise having a diabetic pupil; the degree of teacher knowledge on diabetes, rated on a scale from 1 to 7 shows a median of 3 and a mode of 4; 47% of teachers feel insecure when having a diabetic pupil because they do not have instructions on actions to take in case a complication occurs; 97% of teachers affirm to know what a hypoglycaemia is, however only 67% and 57% of them recognise its signs and symptoms and know how to act when they occur. CONCLUSIONS: The school integration and acceptance of pupils with IDDM is good, according to both teachers and parents. Children with IDDM take responsibility for their disease at an early age and are able to develop certain skills. However they still need help, which they get from their family even during school hours. Generally, teachers are willing to learn new skills to be able to help these children, however, further training is required to improve the understanding and management of this disease.

Necesidades del niño escolarizado con diabetes mellitus. Visión de padres y profesores / Special needs of schoolchildren with diabetes mellitus. Point of view of parents and teachers

Fundamentos: el cuidado diario del niño y el adolescente con diabetes mellitus insulinodependiente (DMID), fundamental para la evolución a corto y largo plazo de la enfermedad, debe incluir las muchas horas de permanencia en la escuela. La presencia, en el entorno escolar, de personas entrenadas para evitar los riesgos de una intervención tardía ante una complicación aguda, como es la hipoglucemia, y facilitar el buen control de la enfermedad puede ser considerada una necesidad. La presencia de personal sanitario en nuestros centros educativos públicos es escasa al no estar establecida como obligatoria. Objetivos: conocer aspectos de la vida cotidiana de los niños con DMID centrados en su jornada escolar y conocer actitudes de profesores de colegios e institutos frente a alumnos con DMID. Pacientes y método: estudio descriptivo, transversal sobre pacientes con DMID de 3 a 18 años atendidos en el área sanitaria 3 de la Comunidad de Madrid y sus respectivos profesores mediante dos tipos de encuesta: primera encuesta, distribuida por la Fundación para la Diabetes, con 80 preguntas dirigidas a pacientes de 3 a 18 años y sus padres en relación con su vida diaria y el entorno escolar. Segunda encuesta, de elaboración propia, dirigida a profesores de enseñanza primaria y secundaria, que valora cómo viven la presencia de estos alumnos con DMID en el aula. Resultados: del cuestionario dirigido a pacientes y padres, fueron válidas 50 en el área correspondiente a nuestro centro, y destacamos que: la mayor participación fue de los niños de 10 a 14 años; el 86% de los niños saben medirse la glucemia y el 66% sabe administrarse insulina; el 74% no ha tenido problemas de inserción escolar; sin embargo, por edades, hasta le 50% de las menores de 6 años lo han padecido; hasta en el 50% de las ocasiones en que un paciente ha precisado la administración de insulina durante el horario escolar lo ha hecho un familiar; el 66% de las hipoglucemias son resueltas por el paciente; sólo disponen de personal sanitario en el centro educativo el 8% de los pacientes y, por último, el 98% cree oportuno que todos los profesores de niños con diabetes tengan información por escrito de los síntomas y pasos a seguir en caso de hipoglucemia cuando el alumno se incorpora al colegio. Del cuestionario dirigido a profesores, respondido por un 54% (76 de un total de 140), destacamos que: el 71% reconoce tener o haber tenido a un alumno diabético; el grado de conocimiento de los profesores sobre diabetes, valorado con una escala del 1 al 7, muestra una mediana de 3 y una moda de 4; la inseguridad generada por un alumno diabético la atribuyen (un 47%) a la falta de instrucciones explícitas sobre la actuación ante complicaciones concretas; el 97,4% de los profesores dicen saber lo que es una hipoglucemia; sin embargo, sólo el 67,1% conoce los signos y síntomas que genera y un 57% dice saber que debe hacer ante esta situación. Conclusiones: la integración y la aceptación escolar de los alumnos con DMID es buena, percepción compartida por padres y profesores. Estos niños desde muy pequeños se responsabilizan de su enfermedad y adquieren habilidades de autocuidado a edades tempranas, pero necesitan ayuda, y ésta es prestada diariamente desde el entorno familiar incluso durante el horario escolar. En general, los profesores muestran una buena disposición para adquirir habilidades que los capaciten para la eventual ayuda a estos niños; sin embargo, su carencia de conocimientos y la ausencia de personal sanitario en los centros educativos hacen necesaria una más amplia información para mejorar la comprensión y la asunción del problema (AU)

Background: The daily care of a diabetic (IDDM) child is essential for the short and long term evolution of the disease, and must include the hours the child spends in school. The presence of Trained personnel are needed who will be able to interveneintime if a serious complication, such as hypoglycemia, occurs. Their presence can help to ensure correct control of the disease and avoid long term complications. Objectives: To understand of the day today life of children with IDDM, focusing on their school hours. To understand the attitude of primary and secondary school teachers towards pupils with IDDM. Patients and methodology: Descriptive and transversal study on IDDM patients between the ages of 3 and18, treated with in the Healthcare Area number 3 in the Madrid Region, and their teachers. Two different kinds of surveys were distributed: the1 stsurvey by Fundación para la Diabetes (Foundation for Diabetes) contained 80 questions aimed at patients between the ages of 3 and 18 and their parents. Questions were related to patient’s daily life and school environment. The 2nd survey, which allowed free response, was aimed at primary and secondary school teachers about their own experiences working as professional swith pupils with IDDM. Results: Fifty questionnaires addressed to parents and patients were valid in our remit, and we emphasize the following: the ages of major participation were10 to14 years; 86% of children knew how to measure blood glucose and 66% how to administer insulin; 74% had no problems with school integration, however, up to 50% of children under 6 years had suffered a problem occasionally; on the 50% of the occasions when a patient needed insulin administration during school hours, it was done by a relative; 66% of hypoglycaemias were resolved by the patient. Health personnel is present only in 8% of the schools studied; 98% of those surveyed think teachers should have written instructions on the signs and symptoms and action to be taken if a hypoglycemia occurs. Questionnaires for teachers were answered by 54% of them (76 of a total of 140), we would like to point out the following: 71% of them recognise having a diabetic pupil; the degree of teacher knowledge on diabetes, rated on a scale from 1 to 7 shows a median of 3 and a mode of 4;47% of teachers feel in secure when having a diabetic pupil because they do not have instructions on actions to take in case a complication occurs; 97% of teachers affirm to know what a hypoglycaemia is, however only 67% and 57% of them recognize its signs and symptoms and know how to act when they occur. Conclusions: The school integration and acceptance of pupils with IDDM is good, according to both teachers and parents. Children with IDDM take responsibility for their disease at an early age and are able to develop certains kills. However they still need help, which they get from their family even during school hours. Generally, teachers are willing to learn new skills to be able to help these children, however, further training is required to improve the understanding and management of this disease (AU)

[Tuberculosis outbreak in a school]. / Brote de tuberculosis en una escuela.

OBJECTIVE: To demonstrate the importance of preventive measures when a case of tuberculosis is detected, identify the causes that favored a tuberculosis outbreak in a school and determine the efficiency of obtaining induced sputum samples. DESIGN: Descriptive, study. SETTING: The Santa Maria de la Providencia school, located in the municipality of Alcala de Henares in Spain. INTERVENTIONS: On April 11, 2005, a case of bacilliform pulmonary tuberculosis was notified in a teacher. Study of contacts in the collective was performed as a programmed intervention. Mantoux skin test and, if positive, chest radiograph were performed in contacts. Treatment of latent or active tuberculosis was recommended according to the result. RESULTS: School exposures were identified and underwent the Mantoux skin test (142 students in years 1, 2, 3, and 4 of compulsory secondary education and 22 teachers). The Mantoux test was positive in 68 students (48 %) and seven teachers (32 %). In seven students with results compatible with active tuberculosis disease, sputum induction was performed and treatment was started. A further two students, identified as contacts, were studied in another center and also started treatment for active tuberculosis disease. Due to the high risk of contagion, study of contacts was extended to the remaining students in compulsory secondary education. In this second phase, 134 students received the Mantoux skin test and seven were Mantoux positive (5.2 %). In all these students, active tuberculosis disease was ruled out. Latent tuberculosis treatment was recommended in all Mantoux-positive contacts.

Brote de tuberculosis en una escuela / Tuberculosis outbreak in a school

Objetivo. Demostrar la importancia de la actuación preventiva ante un caso de tuberculosis. Identificar las causas que favorecieron dicho brote. Comprobar la rentabilidad de la obtención de muestras mediante la inducción del esputo. Diseño. Estudio descriptivo. Emplazamiento. Colegio Santa María de la Providencia, ubicado en el municipio de Alcalá de Henares. Intervenciones. El 11 de abril de 2005 se notificó un caso de tuberculosis pulmonar bacilífera en un profesor de escuela. Como intervención programada se realizó el estudio de contactos del colectivo. Se realizó la prueba de tuberculina y radiografía de tórax (si tenían tuberculina positiva) a los contactos, recomendando tratamiento de la infección tuberculosa latente o de la enfermedad tuberculosa según el resultado. Resultados. Inicialmente se identificó el círculo de expuestos al caso, realizándose la prueba de tuberculina. En total la prueba se llevó a cabo en 142 alumnos de los grupos 1.º, 2.º, 3.º y 4.º de ESO y 22 profesores del claustro. Los resultados de la lectura de la prueba de tuberculina suponen un total de 68 alumnos con prueba (+) (48 %) y 7 profesores con prueba (+) (32 %). Los pacientes con hallazgos compatibles con enfermedad tuberculosa (7 alumnos) fueron citados para recoger muestras respiratorias, mediante la técnica del esputo inducido, e inicio de tratamiento. Otros 2 alumnos del centro escolar, identificados como expuestos, fueron estudiados en otro centro, iniciando ambos igualmente tratamiento de la enfermedad tuberculosa. Debido al elevado riesgo de contagio, se decide ampliar el estudio de contactos al resto de alumnos de ESO. En esta segunda fase se realizó la prueba a un total de 134 alumnos, de los cuales 7 tuvieron la prueba de tuberculina (+) (5,2 %). Se descartó mediante radiología, la presencia de enfermedad tuberculosa en todos ellos. A todos los contactos con prueba de tuberculina (+) se recomendó tratamiento de la infección tuberculosa latente

Objective. To demonstrate the importance of preventive measures when a case of tuberculosis is detected, identify the causes that favored a tuberculosis outbreak in a school and determine the efficiency of obtaining induced sputum samples. Design. Descriptive, study. Setting. The Santa Maria de la Providencia school, located in the municipality of Alcala de Henares in Spain. Interventions. On April 11, 2005, a case of bacilliform pulmonary tuberculosis was notified in a teacher. Study of contacts in the collective was performed as a programmed intervention. Mantoux skin test and, if positive, chest radiograph were performed in contacts. Treatment of latent or active tuberculosis was recommended according to the result. Results. School exposures were identified and underwent the Mantoux skin test (142 students in years 1, 2, 3, and 4 of compulsory secondary education and 22 teachers). The Mantoux test was positive in 68 students (48 %) and seven teachers (32 %). In seven students with results compatible with active tuberculosis disease, sputum induction was performed and treatment was started. A further two students, identified as contacts, were studied in another center and also started treatment for active tuberculosis disease. Due to the high risk of contagion, study of contacts was extended to the remaining students in compulsory secondary education. In this second phase, 134 students received the Mantoux skin test and seven were Mantoux positive (5.2 %). In all these students, active tuberculosis disease was ruled out. Latent tuberculosis treatment was recommended in all Mantoux-positive contacts

[Adverse reaction of pseudoephedrine]. / Reacción adversa por seudoefedrina.

We present a case of a 7 years old girl who developed an episode of myoclonic movements and tremors after being medicated with a not well quantified amount of a pseudoephedrine/antihistamine combination. We want to highlight the potential toxicity of pseudoephedrine, usually administered as part of cold-syrup preparations which are used for symptomatic treatment of upper respiratory tract cough and congestion associated with the common cold and allergic rhinitis. Although these products are generally considered to be safe either by physicians and parents, we can't underestimate the potential adverse events and toxic effects that can occur when administering these medications.

Reacción adversa por seudoefedrina / Adverse reaction of pseudoephedrine

Aportamos el caso de una niña de 7 años de edad que presentó un episodio de mioclonías y temblores de pocas horas de duración tras haber ingerido una cantidad no bien determinada de un preparado que contenía antihistamínico y seudoefedrina. Queremos destacar la potencial toxicidad de la seudoefedrina, comercializada en asociación con antihistamínicos y que se vende como fármaco para aliviar el resfriado común y la obstrucción nasal. Dichos productos se consideran medicamentos para tratar síntomas a menudo banales, por lo que pensamos que la población y, con menos frecuencia, los profesionales, pueden infravalorar la potencial toxicidad de los fármacos que los componen (AU)

We present a case of a 7 years old girl who developed an episode of myoclonic movements and tremors after being medicated with a not well cuantified amount of a pseudoephedrine/antihistamine combination. We want to highlight the potencial toxicity of pseudoephedrine, usually administered as part of cold-syrup preparations which are used for symptomatic treatment of upper respiratory tract cough and congestion associated with the common cold and allergic rhinitis. Although these products are generally considered to be safe either by physicians and parents, we can’t underestimate the potencial adverse events and toxic effects that can occur when administering these medications We present a case of a 7 years old girl who developed an episode of myoclonic movements and tremors after being medicated with a not well cuantified amount of a pseudoephedrine/antihistamine combination. We want to highlight the potencial toxicity of pseudoephedrine, usually administered as part of cold-syrup preparations which are used for symptomatic treatment of upper respiratory tract cough and congestion associated with the common cold and allergic rhinitis. Although these products are generally considered to be safe either by physicians and parents, we can’t underestimate the potencial adverse events and toxic effects that can occur when administering these medications (AU)

Osteomielitis por Salmonella grupo B en paciente portador sano / Osteomyelitis due to Salmonella group B in a healthy carrier

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La hepatitis aguda puede formar parte de la escarlatina / Acute hepatitis may form part of scarlet fever

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[Variables influencing duration of hospitalization for urinary tract infection]. / Variables que influyen en la duración de la hospitalización por infección del tracto urinario.

BACKGROUND: The need for hospitalization and its duration in children with urinary tract infections (UTI) are controversial. OBJECTIVE: To analyze the effect of certain clinical factors from the medical records of children hospitalized with UTI to determine which factors have the greatest influence on length of hospital stay. MATERIAL AND METHODS: A retrospective study of the medical records of 93 patients admitted to our department with a diagnosis of UTI between May 1998 and June 2000 was carried out. All cases were confirmed by bacteriological analysis. The variables analyzed included age, sex, duration of fever before and during admission, temperature, length of intravenous antibiotic therapy, administration of aminoglycosides, presence of urinary tract malformations, previous episodes of UTI, and length of hospital stay. RESULTS: The variables with the greatest influence on a length of hospital stay of more than 7 days were age, especially an age of less than 24 months (OR 3.42; 95 % CI 1.2-9) and the number of days with fever during hospitalization (more than 2 days: OR 2.73; 95 % CI 1.07-7.6). CONCLUSION: Patient age significantly influences length of hospital stay in children with UTI. To optimize resources, ambulatory treatment of children with UTI should be encouraged, even in those younger than 2 years.

Variables que influyen en la duración de la hospitalización por infección del tracto urinario / Variables influencing duration of hospitalization for urinary tract infection

Antecedentes: La necesidad de tratamiento hospitalario y la duración de la hospitalización en niños con diagnóstico de infección del tracto urinario (ITU), con frecuencia son controvertidas. Objetivo: Se analizan algunas variables de las historias clínicas de niños hospitalizados con ITU, con el fin de comprobar cuál o cuáles de ellas han influido más en la duración de la hospitalización. Material y métodos: Estudio retrospectivo mediante revisión de historias clínicas de 93 niños hospitalizados entre mayo de 1998 y junio de 2000, con diagnóstico de ITU confirmado bacteriológicamente. Se analizaron las variables: edad, sexo, número de días de fiebre previos al ingreso, número de días con fiebre durante el ingreso, fiebre elevada, número de días de antibioticoterapia intravenosa, administración de aminoglicósidos, presencia de anomalías morfológicas de las vías urinarias, episodios previos de ITU y número de días de hospitalización. Resultados: Se demuestra que la edad, en particular cuando es menor de 24 meses (odds ratio [OR] 3,42; intervalo de confianza [IC] 95% 1,2-9) y el número de días de fiebre durante la hospitalización (más de 2 días, OR 2,73; IC 95% 1,07-7,6), son las variables que más influyen en el hecho de permanecer hospitalizados más o menos de una semana. Conclusión: Si la variable más influyente en la duración de la hospitalización por ITU es la edad, pensamos que es posible optimizar los recursos promoviendo un manejo más ambulatorio de este proceso, aun en niños menores de 2 años (AU)

Actualización de la farmacopea más utilizada en el tratamiento antiasmático / Update of the antiasthmatic pharmacopoeia existing in Spain

Realizamos una actualización de la farmacopea existente en España en el tratamiento del niño asmático. En forma de tablas, recogemos las distintas composiciones y formas de presentación de los fármacos más utilizados en nuestro país, así como su forma de administración (oral, inhalada o nebulizada) (AU)

Artritis reactiva tras infección reciente por estreptococo betahemolítico del grupo A y Salmonella del grupo B / Reactive Arthritis shortly after Streptococcus B-Hemolyticustype a and Salmonella type B infection

Se expone el caso clínico de una niña de 2 años y 8 meses de edad que presentó monoartritis de rodilla de instauración y resolución lentas, poco después de haber presentado una faringitis aguda y un proceso diarreico entre 1 y 2 semanas antes, respectivamente. Los datos complementarios sugieren que se trata de una artritis reactiva tras una infección estreptocócica, demostrándose además Salmonella en heces. La artritis reactiva postestreptocócica, a diferencia de la fiebre reumática, suele tener un curso clínico lento y no cumple los criterios de Jones. La coincidencia en el tiempo con el padecimiento de una infección gastrointestinal por Salmonella plantea la posibilidad de que la asociación de ambos gérmenes, productores por sí mismos de artritis reactiva, posean una actuación sinérgica en el paciente referido (AU)

Nebulización continua con salbutamol en el tratamiento del asma aguda en niños / Continuous albuterol nebulization in the treatment of acute asthma in children

Objetivos: Diseñar un sistema sencillo para la nebulización continua con salbutamol (NCS) y valorar la seguridad y eficacia en una planta de hospitalización pediátrica. Material y métodos: Realizamos un estudio prospectivo durante 1 año comparando la NCS con la nebulización intermitente de salbutamol (NIS) en niños mayores de 2 años que requirieron ingreso por asma. Fueron excluidos los pacientes con enfermedad cardiaca conocida o con valores elevados de creatinfosfocinasa (CPK) al ingreso. En el grupo de NCS se registró la duración y la dosis de salbutamol nebulizado. La nebulización se efectuó con una solución estandarizada de salbutamol de 0,33 mg/mL. Resultados: Fueron incluidos en el estudio 44 pacientes: 21 en el grupo de NCS y 23 en el de NIS. La NCS se administró a niños que pesaban entre 14,4 y 55,6 kg (media 27) y se mantuvo durante 19,7 h (intervalo: 5-72 h). La dosis media de salbutamol en NCS fue 0,16 mg/kg/h (intervalo: 0,07-0,27 mg/kg/h) y la dosis total de 67,16 mg (20-172). No se objetivaron alteraciones electrolíticas y la CPK permaneció en niveles normales. No se apreciaron diferencias entre ambos grupos en días de hospitalización ni en tiempo de oxigenoterapia. Conclusiones: La NCS es un procedimiento sencillo y seguro, en las dosis empleadas, fuera del ámbito de una unidad de cuidados intensivos. Ninguno de los pacientes precisó aminofilina i.v. ni ingreso en una unidad de cuidados intensivos pediátricos (UCIP). La NCS debería usarse en las crisis de asma moderada a grave antes de pasar a terapias más agresivas (AU)

Alpha-1 antichymotrypsin levels are actively increased in normal colostrum.

BACKGROUND: It is well known that human colostrum has important antiinflammatory functions. The purpose of the current study was to determine antiprotease levels in colostrum and serum and to assess the importance of local synthesis and the electrophoretic differences in both locations. METHODS: Five protease inhibitors were determined by radical immunodiffusion in colostrum and serum samples taken simultaneously from 50 healthy women, 36 to 72 hours after delivery. RESULTS: Antithrombin II, inter-alpha trypsin inhibitor, and alpha-2 macroglobulin levels were undetectable in colostrum. Mean antitrypsin levels in colostrum were 6% of serum levels, but colostrum alpha-1 antichymotrypsin was higher than expected (0.39+/-0.34 g/l) in relation according to the albumin passive transport, and their mean value was 41% of serum levels. Colostrum antichymotrypsin levels did not correlate with serum antichymotrypsin levels or with colostrum albumin levels. The antichymotrypsin molecule in colostrum had a slower electrophoretic mobility when compared with that of serum antichymotrypsin, and it showed a different pattern in Western blot analysis, with a predominating 80-kDa molecule. CONCLUSIONS: Although the origin of colostral antichymotrypsin is unclear, local production in breast epithelial cells is likely. Antichymotrypsin is increased in colostrum, and its molecule has some characteristic differences, suggesting that it has an important and specific role in infant nutrition during breast milk feeding.